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Surgery in the United Kingdom

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https://www.readbyqxmd.com/read/27926555/avoiding-radical-surgery-in-elderly-patients-with-rectal-cancer-is-cost-effective
#1
Christopher Rao, Arthur Sun Myint, Thanos Athanasiou, Omar Faiz, Antony Paul Martin, Brendan Collins, Fraser McLean Smith
BACKGROUND: Radical surgery is associated with significant perioperative mortality in elderly and comorbid populations. Emerging data suggest for patients with a clinical complete response after neoadjuvant chemoradiotherapy that a watch-and-wait approach may provide equivalent survival and oncological outcomes. OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of watch and wait and radical surgery for patients with rectal cancer after a clinical complete response following chemoradiotherapy...
January 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27909127/costs-quality-of-life-and-cost-effectiveness-of-arthroscopic-and-open-repair-for-rotator-cuff-tears-an-economic-evaluation-alongside-the-ukuff-trial
#2
J Murphy, A Gray, C Cooper, D Cooper, C Ramsay, A Carr
AIMS: A trial-based comparison of the use of resources, costs and quality of life outcomes of arthroscopic and open surgical management for rotator cuff tears in the United Kingdom NHS was performed using data from the United Kingdom Rotator Cuff Study (UKUFF) randomised controlled trial. PATIENTS AND METHODS: Using data from 273 patients, healthcare-related use of resources, costs and quality-adjusted life years (QALYs) were estimated at 12 months and 24 months after surgery on an intention-to-treat basis with adjustment for covariates...
December 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27898680/a-core-outcome-set-for-the-benefits-and-adverse-events-of-bariatric-and-metabolic-surgery-the-bariact-project
#3
Karen D Coulman, James Hopkins, Sara T Brookes, Katy Chalmers, Barry Main, Amanda Owen-Smith, Robert C Andrews, James Byrne, Jenny L Donovan, Graziella Mazza, Barnaby C Reeves, Chris A Rogers, Janice L Thompson, Richard Welbourn, Sarah Wordsworth, Jane M Blazeby
BACKGROUND: Bariatric and metabolic surgery is used as a treatment for patients with severe and complex obesity. However, there is a need to improve outcome selection and reporting in bariatric surgery trials. A Core Outcome Set (COS), an agreed minimum set of outcomes reported in all studies of a specific condition, may achieve this. Here, we present the development of a COS for BARIAtric and metabolic surgery Clinical Trials-the BARIACT Study. METHODS AND FINDINGS: Outcomes identified from systematic reviews and patient interviews informed a questionnaire survey...
November 2016: PLoS Medicine
https://www.readbyqxmd.com/read/27893582/basic-burns-management-e-learning-a-new-teaching-tool
#4
Francesco M Egro
Burns teaching is organized only in a few medical schools in the United Kingdom. An e-learning tutorial was developed with the objective of incorporating burns teaching within the medical school curriculum. A 33-webpage e-learning was created, covering topics such as local and general response to burns, assessment of burns, first aid, primary and secondary survey, and referral guidelines. Medical student satisfaction was then evaluated using a 12-question feedback survey rated based on a Likert scale from 1 (very poor) to 5 (very good)...
November 11, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/27834599/the-management-and-outcome-for-patients-with-chronic-subdural-hematoma-a-prospective-multicenter-observational-cohort-study-in-the-united-kingdom
#5
Paul M Brennan, Angelos G Kolias, Alexis J Joannides, Jonathan Shapey, Hani J Marcus, Barbara A Gregson, Patrick J Grover, Peter J Hutchinson, Ian C Coulter
OBJECTIVE Symptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland...
November 11, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27833483/acquired-hypernatremia-in-a-general-surgical-intensive-care-unit-incidence-and-prognosis
#6
Mariam A Alansari, Ahmed Abdulmomen, Mohammed Hussein, Ahmad Mohmmad Zubaidi, Jalal T Alswaiti
PURPOSE: Intensive Care Unit (ICU)-acquired hypernatremia (IAH) is a serious electrolyte disturbance that recently was shown to present an independent risk factor for mortality in critically ill patients. IAH has not been widely investigated in Surgical ICU (SICU) patients. No study has specifically investigated IAH epidemiology in the Kingdome of Saudi Arabia (KSA) in general SICU. The objectives of this study are to assess the epidemiological characteristics and prognostic impact of IAH on SICU mortality and outcome in KSA and compare it with international figures...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27820610/national-registry-data-and-record-linkage-to-inform-postmarket-surveillance-of-prosthetic-aortic-valve-models-over-15-years
#7
Graeme L Hickey, Ben Bridgewater, Stuart W Grant, John Deanfield, John Parkinson, Alan J Bryan, Malcolm Dalrymple-Hay, Neil Moat, Iain Buchan, Joel Dunning
Importance: Postmarket evidence generation for medical devices is important yet limited for prosthetic aortic valve devices in the United Kingdom. Objective: To identify prosthetic aortic valve models that display unexpected patterns of mortality or reintervention using routinely collected national registry data and record linkage. Design, Setting, and Participants: This observational study used data from all National Health Service and private hospitals in England and Wales that submit data to the National Adult Cardiac Surgery Audit (NACSA)...
November 7, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27803215/the-three-legged-stool-a-system-for-spinal-informed-consent
#8
EDITORIAL
J M Powell, A Rai, M Foy, A Casey, H Dabke, A Gibson, M Hutton
Many hospitals do not have a structured process of consent, the attainment of which can often be rather 'last-minute' and somewhat chaotic. This is a surprising state of affairs as spinal surgery is a high-risk surgical specialty with potential for expensive litigation claims. More recently, the Montgomery ruling by the United Kingdom Supreme Court has placed the subject of informed consent into the spotlight. There is a paucity of practical guidance on how a consent process can be achieved in a busy clinical setting...
November 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27801359/bed-utilisation-in-an-irish-regional-paediatric-unit-a-cross-sectional-study-using-the-paediatric-appropriateness-evaluation-protocol-paep
#9
Coilín ÓhAiseadha, Mai Mannix, Jean Saunders, Roy K Philip
BACKGROUND: Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources...
May 10, 2016: International Journal of Health Policy and Management
https://www.readbyqxmd.com/read/27798453/patient-completed-preoperative-web-based-anaesthetic-assessment-questionnaire-electronic-personal-assessment-questionnaire-preoperative-development-and-validation
#10
Iain M Goodhart, John Andrzejowski, Georgina Jones, Mireille Berthoud, Andy Dennis, Gary Mills, Stephen Radley
BACKGROUND: Worldwide, guidelines support the routine use of anaesthetic preoperative assessment (POA), a process that is frequently supported by pro formas and unvalidated questionnaires. Electronic questionnaires can provide reliable data. A local initiative has seen the development of a computerised electronic Personal Assessment Questionnaire (ePAQ). OBJECTIVE: To develop and validate a novel electronic instrument for POA. DESIGN: The content and face validity were evaluated in 30 patients...
October 27, 2016: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/27795950/is-there-a-weekend-effect-in-hip-fracture-patients-presenting-to-a-united-kingdom-teaching-hospital
#11
John Abraham Mathews, Madhavi Vindlacheruvu, Vikas Khanduja
AIM: To compare mortality and time-to-surgery of patients admitted with hip fracture to our teaching hospital on weekdays vs weekends. METHODS: Data was prospectively collected and retrospectively analysed for 816 hip fracture patients. Multivariate logistic regression was carried out on 3 binary outcomes (time-to-surgery < 36 h; 30-d mortality; 120-d mortality), using the explanatory variables time-of-admission; age; gender; American Society of Anesthesiologist (ASA) grade; abbreviated mental test score (AMTS); fracture type; accommodation admitted from; walking ability outdoors; accompaniment outdoors and season...
October 18, 2016: World Journal of Orthopedics
https://www.readbyqxmd.com/read/27791248/ethnic-variation-in-vitreoretinal-surgery-differences-in-clinical-presentation-and-outcome
#12
Bhaskar Gupta, James E Neffendorf, Roger Wong, David A H Laidlaw, Tom H Williamson
PURPOSE: The true prevalence of retinal detachment and other vitreoretinal disorders in different ethnic groups is not well-established. Understanding differences in vitreoretinal disease prevalence is important to appropriately allocate resources to meet demand where ethnic variation in the community exists. The aim of this study is to provide hospital-based data on the proportion of people with vitreoretinal disorders in the 3 main ethnic groups in the United Kingdom: Caucasian, Afro-Caribbean, and South Asian...
October 22, 2016: European Journal of Ophthalmology
https://www.readbyqxmd.com/read/27783141/emergency-abdominal-surgery-in-the-elderly-can-we-predict-mortality
#13
Anna E Sharrock, Jenny McLachlan, Robert Chambers, Ian S Bailey, James Kirkby-Bott
BACKGROUND: The United Kingdom population is ageing. Half of patients requiring an emergency laparotomy are aged over 70, 20 % die within 30 days, and less than half receive good care. Frailty and delay in management are associated with poor surgical outcomes. P-POSSUM risk scoring is widely accepted, but its validity in patients aged over 70 undergoing emergency laparotomy is unclear. AIMS: To assess if P-POSSUM risk stratification reliably predicts inpatient mortality in this group and establish whether those who died within 30 days received delayed care...
October 25, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27776914/the-fate-of-small-size-pericardial-heart-valve-prostheses-in-an-older-patient-population
#14
Ruggero De Paulis, Salvatore D'Aleo, Alessandro Bellisario, Andrea Salica, Luca P Weltert, Raffaele Scaffa, Lorenzo Guerrieri Wolf, Daniele Maselli, Michele Di Mauro
BACKGROUND: Structural valve deterioration (SVD) is the Achilles' heel of bioprostheses. Its correlation with younger age is well known. In recent years we exclusively reserved use of small-size Mitroflow valve prostheses (LivaNova, London, United Kingdom) to an older patient population with small aortic annuli. This study aimed to assess the incidence of SVD and its effect on patient survival and need for reoperation. MATERIALS AND METHODS: Two hundred five patients (aged 75...
September 28, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27726283/survey-of-glaucoma-surgical-preferences-and-post-operative-care-in-the-united-kingdom
#15
Ignacio Rodriguez-Una, Augusto Azuara-Blanco, Anthony J King
BACKGROUND: To evaluate the spectrum of glaucoma surgery and the post-operative follow-up regimes undertaken among glaucoma specialists in the United Kingdom. DESIGN: National survey. PARTICIPANTS: Seventy-five glaucoma specialists (consultants and fellows). METHODS: An eight-question survey was emailed to all glaucoma subspecialists members of the United Kingdom and Eire Glaucoma Society. MAIN OUTCOME MEASURES: Surgery undertaken, post-operative management, awareness of intervention tariff and handling of the follow-up burden generated through surgery...
October 11, 2016: Clinical & Experimental Ophthalmology
https://www.readbyqxmd.com/read/27697247/effect-of-cataract-surgery-training-on%C3%A2-operating-room-productivity-how%C3%A2-long%C3%A2-trainees-take
#16
Dong Young Park, Andrew Walkden, Timothy A De Klerk
PURPOSE: To determine the effect of specialty training on cataract operation times and operating room efficiency. SETTING: Manchester Royal Eye Hospital, Manchester, United Kingdom. DESIGN: Retrospective consecutive case series. METHODS: Specialty training and consultant case times with preparation times were recorded between August 2014 and May 2015. Cases with posterior capsule rupture requiring anterior vitrectomy or iris hook insertion were analyzed...
September 2016: Journal of Cataract and Refractive Surgery
https://www.readbyqxmd.com/read/27697244/clinical-outcomes-of-a-new-extended-range-of-vision-intraocular-lens-international-multicenter-concerto-study
#17
Béatrice Cochener
PURPOSE: To analyze the clinical outcomes after implantation of an extended range of vision intraocular lens (IOL), the Tecnis Symfony, in a routine clinical setting. SETTING: Forty clinical sites in Finland, France, Germany, Norway, Spain, Sweden, and the United Kingdom. DESIGN: Prospective case series. METHODS: The study comprised 411 patients who had bilateral implantation of the extended range of vision IOL, with intended micro-monovision in 1 group (monovision group) and intended emmetropia in the other group (non-monovision group)...
September 2016: Journal of Cataract and Refractive Surgery
https://www.readbyqxmd.com/read/27692903/intubated-versus-nonintubated-general-anesthesia-or-video-assisted-thoracoscopic-surgery-a-case-control-study
#18
Joanne F Irons, Lachlan F Miles, Kaustuv R Joshi, Andrew A Klein, Marco Scarci, Piergiorgio Solli, Guillermo Martinez
OBJECTIVE: General anesthesia with endobronchial intubation and one-lung positive-pressure ventilation always has been considered mandatory for thoracic surgery. Recently, there has been interest in nonintubated techniques for video-assisted thoracoscopic surgery (VATS) in awake and sedated patients. The authors' center developed a nonintubated technique with spontaneous ventilation with the patient under general anesthesia using a supraglottic airway device. The authors believe that this was the first study to compare a nonintubated general anesthetic technique with an intubated general anesthetic technique for VATS...
July 7, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27689452/financial-burden-secondary-to-delay-in-cholecystectomy-following-mild-biliary-pancreatitis
#19
Mohamed H Boshnaq, Nabeel Merali, Islam H El Abbassy, Sayed A Eldesouky, Mohamed A Rabie
AIM OF THE STUDY: The guidelines recommend that patients with mild gallstones pancreatitis should undergo a definitive management for gallstones during the same admission or within the next two weeks. The aim of this study was to estimate the financial cost resulting from a delay in surgical management following mild gallstones pancreatitis. This includes the costs of readmissions with biliary events and the subsequent investigations required during these admissions. MATERIALS AND METHODS: A retrospective analysis included patients with gallstone pancreatitis who were admitted to a district general hospital in the United Kingdom over one year...
September 30, 2016: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/27684059/arthroscopy-of-the-dorsal-and-plantar-pouches-of-the-tarsocrural-joint-for-the-treatment-of-osteochondritis-dissecans-in-the-horse-clinical-features-and-follow-up
#20
Oliver James, Richard Payne, Andrew Bathe, Tim Greet, Claire Wylie
OBJECTIVE: To describe the clinical details and pathology within the dorsal and plantar pouches of the tarsocrural joint of a population of horses that underwent arthroscopic surgery for tarsocrural osteochondritis dissecans (OCD). STUDY DESIGN: Retrospective cohort study. ANIMALS: Horses referred for arthroscopic treatment of tarsocrural OCD between 2005 and 2013 (102 horses; 144 joints). METHODS: Case records of all horses that had tarsocrural arthroscopy for OCD at Rossdales Equine Hospital, Newmarket, United Kingdom were included...
September 29, 2016: Veterinary Surgery: VS
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