The British journal of surgery
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Pain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10-50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new-onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety. ⋯ There is a need for more evidence about interventions for CPSP. High-quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.
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A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical procedures. ⋯ MIS was associated with significantly fewer 30-day postoperative complications, unplanned readmissions and deaths, as well as shorter hospital stay, in patients undergoing colectomy, prostatectomy, hysterectomy or appendicectomy. No benefits were noted for inguinal hernia repair.
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Certification of completion of training in general surgery in the UK requires demonstration of competence in index operations by means of three level 4 competence consultant-validated procedure-based assessments (PBAs). The aim of this study was to evaluate the trajectory of operative learning curves related to PBA performance levels for curriculum-defined indicative operations with respect to numbers performed and training time. ⋯ Significant learning curve gradient variance was observed, with discrepancies between expected indicative operative numbers and the point at which competence was judged to have been achieved. Numbers of index operations to achieve certification of completion of training warrant further examination.
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Observational Study
Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone.
Surgical task-sharing may be central to expanding the provision of surgical care in low-resource settings. The aims of this paper were to describe the set-up of a new surgical task-sharing training programme for associate clinicians and junior doctors in Sierra Leone, assess its productivity and safety, and estimate its future role in contributing to surgical volume. ⋯ SACHOs rapidly and safely achieved substantial increases in surgical volume in Sierra Leone.
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Oesophageal adenocarcinoma (OAC) is a highly aggressive malignancy with poor survival, which is highly variable amongst patients with comparable conventional prognosticators. Therefore molecular biomarkers are urgently needed to improve the prediction of survival in these patients. SRY (sex determining region Y)-box 2, also known as SOX2, is a transcription factor involved in embryonal development of the gastrointestinal tract as well as in carcinogenesis. The purpose of this study was to see whether SOX2 expression is associated with survival in patients with OAC. ⋯ SOX2 is an independent prognostic factor for long-term survival in OAC, especially in patients with stage I OAC.