Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 2010
Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards.
Healthcare-associated infections cost the UK National Health Service 1 billion UK pounds per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance. ⋯ This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.
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Ann R Coll Surg Engl · Apr 2010
Multicenter StudyEvaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases.
In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates. ⋯ Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.
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Ann R Coll Surg Engl · Apr 2010
Case ReportsImplantation of an intercostal nerve stimulator for chronic abdominal pain.
Chronic abdominal pain is not uncommon and can be difficult to manage. We present the case of a 17-year-old man with a 4-year history of chronic abdominal pain. ⋯ We report the successful implantation of a right D11 intercostal nerve stimulator to control the patient's pain. This is the first report of an implantable intercostal nerve stimulator to control intractable chronic abdominal pain.
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Ann R Coll Surg Engl · Mar 2010
Case ReportsUnusual cause of acute abdomen--omental infarction occurring in a child with cyclical neutropenia.
Omental infarction is a rare cause of acute abdomen in childhood. We describe a case of omental infarction mimicking acute appendicitis occurring in a child with cyclical neutropenia. Neutropenic enterocolitis, a serious cause of the acute abdomen, has been linked with cyclical neutropenia. ⋯ If after imaging the diagnosis is in doubt, there should be a low threshold for laparoscopy. The low incidence of omental infarction will continue to mean that it is a diagnosis made at operation for suspected appendicitis. In these cases, the infarcted tissue may be removed by the laparoscopic or open technique.