Surg J R Coll Surg E
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Surg J R Coll Surg E · Feb 2014
The importance of the orthopaedic doctors' appearance: a cross-regional questionnaire based study.
Critics of the Department of Health 'bare below the elbow' guidelines have raised concerns over the impact of these dress regulations on the portrayed image and professionalism of doctors. However, the importance of the doctor's appearance in relation to other professional attributes is largely unknown. The purpose of this study was to determine the opinion of patients on the importance of appearance and the style of clothing worn by doctors. ⋯ The doctors' appearance is of importance to patients and their relatives, but they view many other attributes as more important than how we choose to dress. While not specifically addressing the role of doctors clothing in the transmission of infection, our results do support the preference of patients for 'bare below the elbows' workplace attire.
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Surg J R Coll Surg E · Dec 2013
Does concentration of surgical expertise improve outcomes for laparoscopic cholecystectomy? 9 year audit cycle.
Evidence from surgery shows that high volume is often associated with better outcomes. The aim of this study was to investigate this principle related to elective laparoscopic cholecystectomy practice. ⋯ Concentrating expertise to those surgeons with interest and commitment to laparoscopic cholecystectomy service led to standardisation and reduction in conversion rates. There is correlation between volume of surgery and outcomes.
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Surg J R Coll Surg E · Dec 2013
ReviewImproving disclosure and management of medical error - an opportunity to transform the surgeons of tomorrow.
Human error is the major causal factor of industrial and transportation accidents and healthcare is not immune to the effects of human error. Medical error can be defined as the failure of the planned action to be completed as intended or the use of a wrong plan to achieve an aim. ⋯ Junior doctors are a unique population, with a higher propensity to medical error. A transition from the current culture of 'name, blame and shame' is required. We need to ensure that the 'learning moment' is seized and that mistakes are learned from and not simply forgotten. Surgery has an opportunity to learn from high risk-industries and incorporate human factors training, into surgical training programs in order to better manage and prevent medical error.
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Surg J R Coll Surg E · Dec 2013
ReviewPelvic fractures presenting with haemodynamic instability: treatment options and outcomes.
The management of trauma patients with haemodynamic instability and an unstable pelvic fracture is an issue of vivid debate in "trauma community". A multidisciplinary approach needs to be instituted regarding the required diagnostic and therapeutic measures. Control of haemorrhage is the first priority. ⋯ It needs to be determined on an institutional basis based on the available local resources such as angiography suite and whole-body CT scan and the expertise of the treating surgical team. Despite the fact that recent advances in diagnostic modalities and trauma care systems have improved the overall outcome of patients with pelvic fractures, the early mortality associated with high-energy pelvic injuries presenting with haemodynamic instability remains high. Any suspected injured person with pelvic ring injury should automatically be taken to a level one-trauma centre where all the facilities required are in place for these patients to survive.
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Surg J R Coll Surg E · Oct 2013
Reduced complication rate after modified binding purse-string-mattress sutures pancreatogastrostomy versus duct-to-mucosa pancreaticojejunostomy.
A 2011 metaanalysis demonstrated no difference in postoperative complications between pancreatogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy with the limitation of heterogeneity among the analysed studies. The present study compares postoperative complications after duct-to-mucosa pancreaticojejunostomy with a modified binding purse-string-mattress sutures pancreatogastrostomy in a teaching hospital. ⋯ In a teaching hospital, modified pancreatogastrostomy seems to be superior to pancreaticojejunostomy regarding pancreatic fistula, especially in patients with a soft, non-fibrotic pancreas and/or a small duct. An ongoing prospective randomised multicentre trial (RECOPANC) might confirm these results.