Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"Optimising topical wound care outcomes for fungating breast wounds - A systematic review of current institutional practice.","authors":"Ryan Seng Hong Wong, Trishan Manav Sri Ram, Zhi Min Lin, Clement Luck Khng Chia","doi":"10.1016/j.surge.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.surge.2024.12.003","url":null,"abstract":"<p><strong>Background: </strong>Fungating breast wounds cause significant complications and morbidity to patients. Wound care is of paramount importance in optimising care and alleviating suffering for patients with malignant breast wounds. Currently, routinely implemented objective assessment tools for fungating breast wound treatment outcomes are non-existent, and institutional practice varies.</p><p><strong>Aims: </strong>This review aims to evaluate current evidence regarding various wound care methodologies for fungating breast tumours on their effectiveness at targeting established fungating wound-specific complications: malodour, pain, exudates, bleeding, wound characteristics, emotional and quality-of-life outcomes.</p><p><strong>Data sources: </strong>We conducted a systematic review of four databases (PubMed, Embase, Scopus, The Cochrane Library) and hand-search of bibliographies of relevant reviews, in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines.</p><p><strong>Results: </strong>The search strategy yielded 1319 articles, of which, 8 studies involving 188 patients were included in the review. Studies examined the effects of wound care products such as but not limited to calcium alginate, hydrocellular dressing and metronidazole and looked at outcomes such as bleeding (6), malodour (5), exudates (3), pain (4), wound size/length (2), emotion (3) and quality-of-life (1).</p><p><strong>Conclusion: </strong>There is a wide variety of options for wound care which is able to target the various complications of fungating breast wounds. Certain wound care methods are effective in alleviating patient morbidity. However, key barriers toward establishing evidenced-based management of patients with fungating breast wounds were identified in the paucity of studies, lack of standardisation of interventions and objective outcome measures.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of neurosurgery conferences in shaping medical student careers.","authors":"Irving Gabriel Calisaya-Madariaga, Gonzalo Jair Callahuanca-Flores","doi":"10.1016/j.surge.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.014","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting trainees in difficulty: A guiding hand through challenging times.","authors":"Michael El Boghdady","doi":"10.1016/j.surge.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.013","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to surgery for acute uncomplicated appendicitis in an adult university teaching hospital.","authors":"Stuart J Cook, Kieran M O'Driscoll, Ahmed Al Maksoud, Denis Evoy, Damian McCartan, Helen M Heneghan, Ruth S Prichard","doi":"10.1016/j.surge.2024.11.011","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.011","url":null,"abstract":"<p><strong>Aims: </strong>Both patient and hospital-related factors determine the timing of appendicectomy for acute uncomplicated appendicitis. Recent literature suggests appendicectomy more than 24 h after hospital admission is associated with increased morbidity in adults. Current guidelines from the World Society of Emergency Surgery (WSES) recommend surgery within this timeframe to reduce the risk of complications. The aim of this study was to determine the time to surgery for patients with acute uncomplicated appendicitis and to compare this to the current WSES recommendations. This study also aimed to identify potential reasons for any in-hospital delay.</p><p><strong>Methods: </strong>This study is a retrospective review of all patients who underwent appendicectomy for confirmed acute uncomplicated appendicitis at an adult university teaching hospital between September 2021 and September 2022. Patient demographics, clinical information, time of admission, time of surgery, time of discharge and surgical complication data were collected.</p><p><strong>Results: </strong>A total of 229 appendicectomies were performed during the study period. 138 (60 %) had a preoperative diagnosis of acute uncomplicated appendicitis. The median age was 36 years (range 17-93). Time to surgery was <24 h in 80 (58 %) patients and >24 h in 58 (42 %) patients. In patients with a delay of >24 h, 28 (48 %) had their surgery 24-36 h after admission, 23 (40 %) had their surgery between 36 and 48 h, and 7 (12 %) had their surgery >48 h after admission. Patients who were operated >24 h after admission had a higher rate of readmission, 4/58 (6.9 %) compared to 1/80 (1.25 %) in the less than 24 h group (p = 0.09). Delays in radiology, surgical ward beds and the lack of a dedicated emergency theatre may have contributed to extended waiting times.</p><p><strong>Conclusion: </strong>The results of this study show that the majority (58 %) of patients within our cohort were operated on within the WSES guidelines. However, 42 % of patients had their surgery in excess of these recommendations. Extended waiting periods may be related to delays in radiology, surgical ward beds and a lack of a dedicated emergency theatre. Patients who were operated on greater than 24 h following their admission also had a higher rate of readmission.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendicular intussusception mimicking caecal polyp: A case report.","authors":"Chirag Pereira, Harish Babu","doi":"10.1016/j.surge.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.surge.2024.12.002","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence and impact of microaggressions within orthopaedics in the United States of America: A systematic review.","authors":"B Azam, A Bakhiet, W Moussa, M A Sajid, M K Qureshi, A Kumar, U A Halim","doi":"10.1016/j.surge.2024.11.010","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.010","url":null,"abstract":"<p><strong>Background: </strong>Microaggressions are being increasingly documented within the medical community. With their rising prevalence, there is concern that microaggressions can lead to suboptimal working environments, victim burnout, and compromised patient safety. Orthopaedics, known for macroaggressions like bullying and sexual discrimination, remains the least diverse specialty, potentially predisposing its staff to microaggressions. The aim of this paper was to determine the prevalence of microaggressions within Trauma and Orthopaedics, and ascertain the impact they have within the specialty.</p><p><strong>Methods: </strong>A systematic review was carried out using PRISMA guidelines. Publications pertaining to microaggressions in orthopaedics in the English language were included, with no restrictions relating to study location, date of publication or the victims of microaggressions.</p><p><strong>Results: </strong>29 papers were included in this systematic review, of which 10 papers were eligible for inclusion. The prevalence of microaggressions in orthopaedics based on gender was discussed in 5 papers, whilst microaggressions relating to race/ethnicity were discussed in 2 papers. A further 2 papers discussed microaggressions relating to both race and gender. All were published in the United States of America (USA). It was found that microaggressions are common in orthopaedics, with 80 % of respondents across 3 cross sectional surveys experiencing some form of microaggression.</p><p><strong>Conclusion: </strong>Microaggressions are a significant problem within the American orthopaedic community. They affect surgeons of all grades, and deter medical students from pursuing orthopaedics as a career. It is important to develop mitigating strategies to tackle this behaviour, in the hope that working environments and patient safety improve in orthopaedic departments.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The general public's perception of robotic surgery - A scoping review.","authors":"Charlotte McDonnell, Michael Devine, Dara Kavanagh","doi":"10.1016/j.surge.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.surge.2024.12.001","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic surgery is typically characterized by the telemanipulation of robotic arms controlled by a surgeon via a command system. Medical technology advancements have caused variations in how robotic surgery is conceptualised. It is important to ascertain the public's perception of robotic surgery, as this impacts decision making.</p><p><strong>Methods: </strong>A study protocol was developed in accordance with the PRISMA guidelines. All original research articles, abstracts, conference proceedings or grey literature were eligible. The Medline (Pubmed), Scopus, and Cochrane Databases, Google Scholar, white and green statement papers, and international guidelines were searched. A preliminary search identified key terms. Title and abstract screening was conducted. Full texts were appraised for eligibility. An inductive extraction process was utilized, grouping data into themes by content analysis, and developing a coding framework. Heterogeneity limited pooling of data and prevented aggregated data analysis. Therefore, NVivo software was used to augment this qualitative process and develop a meta-synthesis.</p><p><strong>Results: </strong>The search yielded 8818 articles across the bibliographic databases. After inclusion of the grey literature 132 full text manuscripts were assessed. 35 of which were included. Three main themes were identified from the coding framework: understanding of robotic surgery, acceptance of robotic surgery, and perceptions of robotic surgery. Micro-construct subthemes included 'understanding of robotic autonomy, surgeon role, and outcomes', 'determinants of understanding', 'sources of information', 'intention to use', and 'determinants of acceptance'. Robotic surgery is perceived as a risky modality by the general public. They have a limited understanding of this surgical approach and the extent of autonomy a robotic system has. Sex, age, and residence are important factors effecting the degree of understanding and intention to undergo robotic surgery.</p><p><strong>Conclusion: </strong>Robotic surgery is perceived as a risky procedure by the general public. They have limited understanding of the modality, and low rates of acceptance to undergo it fearing greater complications.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of inadequate disclosure and patient recall on the consent process in neurosurgery: A systematic literature review.","authors":"Ashraf Elmahdi, David Smith","doi":"10.1016/j.surge.2024.11.009","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.009","url":null,"abstract":"<p><strong>Background: </strong>The informed consent process in neurosurgery aims to uphold patient autonomy and provide comprehensive information for decision-making. However, gaps in communication and understanding between patients and surgeons persist. This systematic review examined the impact of consent on neurosurgical practice, exploring the effectiveness of different consent approaches.</p><p><strong>Methods: </strong>A comprehensive search of databases and relevant sources identified twenty-eight studies for inclusion. Prospective and retrospective studies were assessed to examine the effect of consent on neurosurgical practice. Data collection and analysis involved independent reviewers assessing eligibility, study quality, and risk of bias. Findings from the included studies were used to write the review.</p><p><strong>Main results: </strong>Randomized controlled trials specific to the impact of consent in neurosurgery needed to be included. Nevertheless, the reviewed twenty-nine studies revealed a significant risk of litigation due to inadequate information provision. Neurosurgeons' adherence to the standard of competent peers was identified as crucial in bridging the gap between desired and actual patient-surgeon interactions.</p><p><strong>Authors conclusions: </strong>This review underscores the need to address communication gaps between patients and surgeons within the informed consent process in neurosurgery. Neurosurgeons must strive to meet the standard of competent peers and implement effective consent strategies involving multiple modalities. Enhancing communication and patient comprehension can mitigate potential litigation risks, ensuring better patient-centred care and shared decision-making in neurosurgical practice.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancements in artificial intelligence for medical examinations: A leap from ChatGPT 3.5 to ChatGPT 4.0 in the FRCS trauma & orthopaedics examination.","authors":"Akib Majed Khan, Khaled Maher Sarraf, Ashley Iain Simpson","doi":"10.1016/j.surge.2024.11.008","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.008","url":null,"abstract":"<p><strong>Introduction: </strong>ChatGPT is a sophisticated AI model capable of generating human-like text based on the input it receives. ChatGPT 3.5 showed an inability to pass the FRCS (Tr&Orth) examination due to a lack of higher-order judgement in previous studies. Enhancements in ChatGPT 4.0 warrant an evaluation of its performance.</p><p><strong>Methodology: </strong>Questions from the UK-based December 2022 In-Training examination were input into ChatGPT 3.5 and 4.0. Methodology from a prior study was replicated to maintain consistency, allowing for a direct comparison between the two model versions. The performance threshold remained at 65.8 %, aligning with the November 2022 sitting of Section 1 of the FRCS (Tr&Orth).</p><p><strong>Results: </strong>ChatGPT 4.0 achieved a passing score (73.9 %), indicating an improvement in its ability to analyse clinical information and make decisions reflective of a competent trauma and orthopaedic consultant. Compared to ChatGPT 4.0, version 3.5 scored 38.1 % lower, which represents a significant difference (p < 0.0001; Chi-square). The breakdown by subspecialty further demonstrated version 4.0's enhanced understanding and application in complex clinical scenarios. ChatGPT 4.0 had a significantly significant improvement in answering image-based questions (p = 0.0069) compared to its predecessor.</p><p><strong>Conclusion: </strong>ChatGPT 4.0's success in passing Section One of the FRCS (Tr&Orth) examination highlights the rapid evolution of AI technologies and their potential applications in healthcare and education.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A boost to concentration or a distracting noise? A systematic review of surgeon and anaesthetist perspectives of the benefit of intra-operative music.","authors":"K Onuoha, D Jones, W Eardley","doi":"10.1016/j.surge.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>The surgical team should be as harmonious and focussed as possible in the operating theatre. Whilst there is evidence of benefit for the use of music in the perioperative period for patient, little exists to inform of impact on those doing the surgery or anaesthesia. This review focuses on the perspectives of surgeons and anaesthetists, their views and opinions on the effect and impact of music during surgery.</p><p><strong>Methods: </strong>A systematic review was conducted using narrative synthesis. The PRISMA guidelines were followed with the use of PICO and PRISMA guided search strategy. PubMed, CINAHL and Medline were searched but filtered to only published English language papers.</p><p><strong>Results: </strong>Of 329 papers identified 42 duplicates were removed. 287 were screened; of which 276 were excluded and 11 sought for retrieval. Of these, 8 were excluded for wrong population or study design, leaving 3 for analysis. Narrative synthesis revealed three themes to guide discussion: (1) Views of surgeons and anaesthetists and the effect on music; (2) effect of music on other staff members; and (3) differences in music choices and balance of power.</p><p><strong>Conclusion: </strong>Music has an overall beneficial effect on surgeons and anaesthetists, especially with regards improved concentration. As an intervention, it has global generalisability and requires little resource. Investigation across different surgical specialities and use of flexible control models in terms of choosing music is a natural subsequent research question.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}