Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Apr 2020
Comparative StudyCollocated burn and fracture injuries in major trauma: a 10 year experience.
Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without. ⋯ There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.
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Ann R Coll Surg Engl · Mar 2020
The diagnostic accuracy of the faecal immunochemical test for colorectal cancer in risk-stratified symptomatic patients.
The faecal immunochemical test detects blood in the faeces, reporting faecal haemoglobin quantitatively in micrograms of haemoglobin per gram of faeces. The aim of this pilot study was to determine the feasibility of using the faecal immunochemical test as a rule-out test in symptomatic patients at low and high risk of colorectal cancer. ⋯ This study shows that the faecal immunochemical test is a promising technology that detected colorectal cancer in all high- or low-risk symptomatic patients in our cohort at a threshold of detectable faecal haemoglobin. Data from adequately powered cohort studies will elucidate the true diagnostic accuracy of the test and the rate and patterns of undetected colorectal cancer.
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Ann R Coll Surg Engl · Feb 2020
Implementation of duty of candour within neurosurgery: a national survey and framework for improved application in clinical practice.
Statutory duty of candour was introduced in November 2014 for NHS bodies in England. Contained within the regulation were definitions regarding the threshold for what constitutes a notifiable patient safety incident. However, it can be difficult to determine when the process should be implemented. The aim of this survey was to evaluate the interpretation of these definitions by British neurosurgeons. ⋯ There is considerable nationwide variation in the interpretation of definitions regarding the threshold for duty of candour. To this end, we propose a framework for the improved application of duty of candour in clinical practice.
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Ann R Coll Surg Engl · Jan 2020
Multicenter Study Observational StudyA multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery (the LapCoGesic study).
Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. ⋯ Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.