Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 2016
An intraoperative irrigation regimen to reduce the surgical site infection rate following adolescent idiopathic scoliosis surgery.
The aim of this study was to compare the efficacy of a gentamicin antibiotic intraoperative irrigation regimen (regimen A) with a povidone-iodine intraoperative irrigation regimen (regimen B) and to evaluate the ability of adjunctive local vancomycin powder (regimen C) to reduce the surgical site infection (SSI) rate following idiopathic scoliosis correction. ⋯ Wound irrigation with a povidone-iodine solution reduces SSIs following adolescent idiopathic scoliosis surgery. The direct application of vancomycin powder to the wound is safe but does not reduce the SSI rate further in low risk patients. Additional studies are needed to elucidate whether it is effective at higher doses and in high risk patient groups.
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Ann R Coll Surg Engl · Mar 2016
ReviewFrailty and cognitive impairment: Unique challenges in the older emergency surgical patient.
Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. ⋯ Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.
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Ann R Coll Surg Engl · Mar 2016
Safe management of paediatric penetrating head injury without a CT scanner: A strategy for humanitarian surgeons based on experience in southern Afghanistan.
In many parts of the world, access to a CT scanner remains almost non-existent, and patients with a head injury are managed expectantly, often with poor results. Recent military medical experience in southern Afghanistan using a well-equipped surgical facility with a CT scanner has provided new insights into safe surgical practice in resource-poor environments. ⋯ In resource-poor environments, clinically-based criteria may be used as a safe and appropriate strategy for selecting children who may benefit from relatively straightforward surgery after penetrating brain injury.
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Ann R Coll Surg Engl · Feb 2016
Best practices for scholarly authors in the age of predatory journals.
'Continuous effort, not strength or intelligence, is the key to understanding our potential.' Margaret J Wheatley. The focus of any academic or research author is to share his or her findings, and to gain respect and reward for publishing. The ideal journal is one that not only publishes an article quickly but also helps the author to improve the article before publication through peer review, selects only the best research so that the author's article lies alongside other high quality articles, and provides maximum (and long-term) visibility and access to the article. ⋯ Check. Submit. (http://thinkchecksubmit.org/), was launched in the latter half of 2015 and hopes to raise awareness of disreputable journals while clearly separating them from valid, high quality, open access journals (of which there are many). PIPPA SMART Guest Editor.
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Ann R Coll Surg Engl · Feb 2016
Review Meta AnalysisSystematic review and meta-analysis of the association between frailty and outcome in surgical patients.
Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear. ⋯ The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients.