JRSM Open最新文献

{"title":"Splenic flexure colonic lipoma causing intussusception.","authors":"Moustafa Moussally,&nbsp;Imad Mokalled,&nbsp;Faek Jamali,&nbsp;Mohamad J Khalife","doi":"10.1177/2054270420983088","DOIUrl":"https://doi.org/10.1177/2054270420983088","url":null,"abstract":"<p><p>Colonic lipomas are rare benign tumours that are usually asymptomatic. However, giant colonic lipomas tend to be symptomatic and can occasionally result in intussusception and intermittent colonic obstruction. As adult intussusception is an uncommon occurrence, the identification of the underlying aetiology is essential due to its high association with malignancy. Computed Tomography remains the tool of choice for the diagnosis of colonic lipomas. Surgical excision remains the mainstay treatment of giant symptomatic colonic lipomas. We hereby present the case of a 51-year-old male found to have a colonic lipoma causing recurrent intussusception. We discuss the approach, diagnostic tools and available treatment modalities for colonic lipomas. We also provide a brief literature review of intussusception in adults.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 1","pages":"2054270420983088"},"PeriodicalIF":0.0,"publicationDate":"2021-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420983088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38854892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical coherence tomography significance in managing complex neurofibromatosis 2-related papilledema: Report of a case.","authors":"Giacomo Maria Bacci,&nbsp;Flavio Giordano,&nbsp;Iacopo Sardi,&nbsp;Gareth Evans,&nbsp;Omar Pathmanaban,&nbsp;Carla Fonte,&nbsp;Franco Trabalzini,&nbsp;Sergio Nappini,&nbsp;Regina Mura,&nbsp;Roberto Caputo","doi":"10.1177/2054270420981454","DOIUrl":"https://doi.org/10.1177/2054270420981454","url":null,"abstract":"<p><p>This case describes the strong utility of optical coherence tomography in multidisciplinary management of a complex case of type 2 neurofibromatosis.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 1","pages":"2054270420981454"},"PeriodicalIF":0.0,"publicationDate":"2021-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420981454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38854891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARS-CoV-2 (COVID-19) PCR cycle threshold: can it help in the timing of urgent cardiac surgery?","authors":"Abdulaziz Alkhulaifi,&nbsp;Shady Mohammed,&nbsp;Hafeez Lone,&nbsp;Mohd Wani,&nbsp;Bassam Shoman,&nbsp;Mawahib Elhassan,&nbsp;Asmaa Althani,&nbsp;Cornelia S Carr","doi":"10.1177/2054270420977365","DOIUrl":"https://doi.org/10.1177/2054270420977365","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has resulted in a significant reduction in urgent cardiac surgery due to concerns about safety for both patients and care givers. The timing of safe cardiac surgery is yet to be clarified in the setting of COVID-19 diagnosis.</p><p><strong>Methods: </strong>Due to the urgency of the cardiac conditions on presentation, we have operated on four patients who exhibited the spectrum of COVID-19 disease from asymptomatic to severe COVID-19 pneumonia. With the evolving knowledge about SARS-CoV-2 and its genetic determinants as well as the cycle threshold levels obtained from real-time reverse transcription polymerase chain reaction, we have attempted to develop a strategy to deal with these patients.</p><p><strong>Results: </strong>All four patients underwent urgent cardiac surgery following a thorough evaluation and multidisciplinary team approach with guidance based on the virus cycle threshold values obtained by reverse transcription polymerase chain reaction.</p><p><strong>Conclusion: </strong>We have shown that, with thorough preparations, consideration of the significance of the cycle threshold obtained on reverse transcription polymerase chain reaction and meticulous timing, COVID-19 diagnosed patients may undergo open heart surgery safely.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 12","pages":"2054270420977365"},"PeriodicalIF":0.0,"publicationDate":"2020-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420977365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38854890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral distal femoral endoprosthesis for trauma.","authors":"Jarrad M Stevens,&nbsp;Nick D Clement,&nbsp;Tom Beckingsale,&nbsp;James T Patton","doi":"10.1177/2054270420970725","DOIUrl":"https://doi.org/10.1177/2054270420970725","url":null,"abstract":"<p><p>In this paper, we describe the outcome of bilateral distal femoral endoprosthesis for the management of acute severe trauma. We also review the literature to ascertain the published functional results of distal femoral endoprosthesis for acute trauma of native knees. In severely comminuted intra-articular fractures, such as those our patient sustained, reconstruction is not always possible, and predictable outcomes can rarely be assured with conviction. Endoprosthesis is an established treatment modality for replacement after resection in limb salvage surgery. In this regard, there is a limited but vital role that endoprosthesis can play in acute complex trauma. We demonstrate a good short-term outcome when bilateral endoprostheses are utilised for complex distal femur trauma.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 11","pages":"2054270420970725"},"PeriodicalIF":0.0,"publicationDate":"2020-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420970725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38854889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study.","authors":"Vari M Drennan,&nbsp;Melania Calestani,&nbsp;Francesca Taylor,&nbsp;Mary Halter,&nbsp;Ros Levenson","doi":"10.1177/2054270420969572","DOIUrl":"https://doi.org/10.1177/2054270420969572","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors.</p><p><strong>Design: </strong>Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis.</p><p><strong>Setting: </strong>Eight acute hospitals, England.</p><p><strong>Participants: </strong>36 medical directors, consultants, junior doctors, nurses and manager, 198 documents.</p><p><strong>Results: </strong>Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates.</p><p><strong>Conclusions: </strong>The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 10","pages":"2054270420969572"},"PeriodicalIF":0.0,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420969572","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38691058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of diet on health and longevity in London 1850-1880.","authors":"Peter Greaves","doi":"10.1177/2054270420969533","DOIUrl":"https://doi.org/10.1177/2054270420969533","url":null,"abstract":"<p><p>This study examines the impact of diet on health in different districts of mid-19th century London. Surveys of London diets and living condition were compared with mortality data between 1851 and 1880. Despite an abundance of fresh foods reaching London, the very poor labouring population living in the inner boroughs between 1850 and 1861 had great difficulty obtaining sufficient nourishment because of its cost. This population showed high death rates from infectious diseases, notably pulmonary tuberculosis, which was endemic and is typically associated with poor nutrition. This high death rate was exacerbated by more deaths from gastrointestinal infections associated with a polluted water supply from the river Thames. By contrast, the poor in the outer suburbs enjoyed both more nutritious diets and cleaner water which was associated with lower death rates comparable to those in rural Britain. Outer suburbs retained a relatively rural life-style associated with cleaner water and an abundance of locally grown food. In the following two decades, there was a significant reduction in the death rates from gastrointestinal infections in the inner boroughs which correlated with the major improvements in London's water supply. The decline in death rates from tuberculosis and other infectious disease was inconsistent and increased in some boroughs, suggesting patchy economic improvement and a persisting limited ability of many of London's poor to afford a nutritious diet.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 9","pages":"2054270420969533"},"PeriodicalIF":0.0,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420969533","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39611742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early career choices for emergency medicine and later career destinations: national surveys of UK medical graduates.","authors":"Trevor W Lambert,&nbsp;Fay Smith,&nbsp;Michael J Goldacre","doi":"10.1177/2054270420961595","DOIUrl":"https://doi.org/10.1177/2054270420961595","url":null,"abstract":"<p><strong>Objective: </strong>To report doctors' early career preferences for emergency medicine, their eventual career destinations and factors influencing their career pathways.</p><p><strong>Design: </strong>Self-administered questionnaire surveys.</p><p><strong>Setting: </strong>United Kingdom.</p><p><strong>Participants: </strong>All graduates from all UK medical schools in selected graduation years between 1993 and 2015.</p><p><strong>Main outcome measures: </strong>Choices for preferred eventual specialty; eventual career destinations; certainty about choice of specialty; correspondence between early specialty choice for emergency medicine and eventually working in emergency medicine.</p><p><strong>Results: </strong>Emergency medicine was chosen by 5.6% of graduates of 2015 when surveyed in 2016, and 7.1% of graduates of 2012 surveyed in 2015. These figures represent a modest increase compared with other recent cohorts, but there is no evidence of a sustained long-term trend of an increase. More men than women specified emergency medicine - in 2016 6.6% vs. 5.0%, and in 2015 7.9% vs. 6.5%. Doctors choosing emergency medicine were less certain about their choice than doctors choosing other specialties. Of graduates of 2005 who chose emergency medicine in year 1, only 18% were working in emergency medicine in year 10. Looking backwards, from destinations to early choices, 46% of 2005 graduates working in emergency medicine in 2015 had specified emergency medicine as their choice of eventual specialty in year 1.</p><p><strong>Conclusions: </strong>There was no substantial increase across the cohorts in choices for emergency medicine. Policy should address how to encourage more doctors to choose the specialty, and to create a future UK health service environment in which those who choose emergency medicine early on do not later change their minds in large numbers.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 8","pages":"2054270420961595"},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420961595","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38575157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Royal Society of Medicine Surgical Innovation Day Adrian Tanner Prize Winner 2019: Multidisciplinary care and surgical innovation for the benefit of the patient with head and neck cancer of unknown primary.","authors":"Rakesh Mistry, Abigail Walker, Nathan Walker, Enyinnaya Ofo","doi":"10.1177/2054270420921066","DOIUrl":"10.1177/2054270420921066","url":null,"abstract":"<p><p>Head and neck carcinoma of unknown primary accounts for approximately 1-5% of all head and neck cancers and presents a genuine diagnostic and therapeutic dilemma. Despite advanced investigations, the primary tumour location remains unknown in up to 40% of these cases. Transoral robotic surgery presents a viable diagnostic and therapeutic option in these patients. This surgical innovation alongside advances in the understanding of head and neck cancer biology means that a multidisciplinary approach in the management of these complex patients is of utmost importance to ensure optimal therapeutic outcomes.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 7","pages":"2054270420921066"},"PeriodicalIF":0.0,"publicationDate":"2020-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/42/10.1177_2054270420921066.PMC7346693.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38169379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperglycaemia-related occipital lobe seizures.","authors":"A Alakkas,&nbsp;P Chen,&nbsp;M Chen,&nbsp;K Longardner,&nbsp;D E Piccioni","doi":"10.1177/2054270420920999","DOIUrl":"https://doi.org/10.1177/2054270420920999","url":null,"abstract":"<p><p>Recognition of the role of hyperglycaemia in seizures is vital, because they tend to refractory to antiepileptic drugs and respond to insulin therapy and hydration.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 6","pages":"2054270420920999"},"PeriodicalIF":0.0,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420920999","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decades of cough: delayed recognition of atypical cystic fibrosis in an adult patient.","authors":"Abhimanyu Chandel,&nbsp;Kevin Pak,&nbsp;Sean Dooley,&nbsp;Krystle Salazar","doi":"10.1177/2054270420921003","DOIUrl":"https://doi.org/10.1177/2054270420921003","url":null,"abstract":"<p><p>We present a case of a 30-year-old male diagnosed with atypical cystic fibrosis. This report demonstrates the heterogeneity of the presentation of this common genetic disease.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"11 6","pages":"2054270420921003"},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420921003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38077846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}