The British journal of surgery
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Multicenter Study Clinical Trial
Diagnostic accuracy of surgeons and trainees in assessment of patients with acute abdominal pain.
Diagnostic accuracy in the assessment of patients with acute abdominal pain in the emergency ward is not adequate. It has been argued that this is because the investigations are carried out predominantly by a trainee. Resource utilization could be lowered if surgeons had a higher initial diagnostic accuracy. ⋯ The diagnostic accuracy of the initial clinical assessment is not improved when a surgeon rather than a surgical trainee assesses a patient with abdominal pain in the emergency department.
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Observational Study
Risk factors for requiring cholecystectomy for gallstone disease in a prospective population-based cohort study.
The relationship between different lifestyle factors and the risk of needing cholecystectomy for gallstone disease is not clear. This study aimed to assess the association between anthropometric, lifestyle and sociodemographic risk factors and the subsequent risk of requiring cholecystectomy for gallstone disease during long-term follow-up in a defined population cohort. ⋯ High BMI and waist circumference increased the risk of having cholecystectomy for both sexes. In women, the risk was increased by HRT, and decreased by hard physical activity and higher educational level.
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Comparative Study
Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours.
Enucleation of pancreatic neuroendocrine tumours (pNETs) via robotic surgery has rarely been described. This study sought to assess the safety and efficiency of robotic surgery for the enucleation of small pNETs. ⋯ NCT02125929 ( https://www.clinicaltrials.gov/).
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The complexity of surgical interventions has major implications for the design of RCTs. Trials need to consider how and whether to standardize interventions so that, if successful, they can be implemented in practice. Although guidance exists for standardizing non-pharmaceutical interventions in RCTs, their application to surgery is unclear. This study reports new methods for standardizing the delivery of surgical interventions in RCTs. ⋯ The typology provides a framework for use during trial design to standardize the delivery of surgical interventions and document these details within protocols. Application of this typology to future RCTs may clarify details of the interventions under evaluation and help successful interventions to be implemented.
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Chronic kidney disease is an important preoperative risk factor. However, the association between renal dysfunction and risk of death has not been well explored in non-cardiac surgery. ⋯ Renal dysfunction is an important risk factor for death after non-cardiac surgery and the risk increases steeply for patients with moderate to severe kidney dysfunction.