Annals of the Royal College of Surgeons of England最新文献_第10页

Injection sclerotherapy for the treatment of haemorrhoids in anticoagulated patients. 用注射硬化剂疗法治疗抗凝患者的痔疮。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-01-01 Epub Date: 2024-01-04 DOI: 10.1308/rcsann.2023.0097

P Batra, A O'Connor, J Walmsley, W Baraza, A Sharma

{"title":"Injection sclerotherapy for the treatment of haemorrhoids in anticoagulated patients.","authors":"P Batra, A O'Connor, J Walmsley, W Baraza, A Sharma","doi":"10.1308/rcsann.2023.0097","DOIUrl":"10.1308/rcsann.2023.0097","url":null,"abstract":"Background: Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation. Injection sclerotherapy (IST) has been proposed as a treatment option for these patients.Methods: A retrospective review of case notes was performed in a colorectal surgery department that sits alongside a tertiary cardiothoracic surgical unit. Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism, except in two patients who required alternative procedures. The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months. The secondary outcomes were patient-reported complications, number of IST procedures and number of other procedures performed to achieve symptom resolution.Results: A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified. Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions. Ten patients (50%) required only one IST procedure, and three patients (15%) required two procedures. The remaining five (25%) patients required three or four interventions. The median time between IST treatments was 32 weeks (range 8-133). No complications were reported.Conclusion: Our study demonstrates that IST can be considered as a potential treatment option for patients with SH who are at a high risk of thromboembolic disease requiring anticoagulation.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"25-28"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors associated with increased radiation exposure in the fixation of proximal femoral fractures. 股骨近端骨折固定术中辐照增加的相关因素。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-01-01 Epub Date: 2024-04-02 DOI: 10.1308/rcsann.2023.0092

A Elbahi, O Thomas, M Dungey, C Randall, D K Menon

{"title":"Factors associated with increased radiation exposure in the fixation of proximal femoral fractures.","authors":"A Elbahi, O Thomas, M Dungey, C Randall, D K Menon","doi":"10.1308/rcsann.2023.0092","DOIUrl":"10.1308/rcsann.2023.0092","url":null,"abstract":"Introduction: When using radiation intraoperatively, a surgeon should aim to keep the radiation dose as low as is reasonably achievable to obtain the therapeutic goal. We aimed to investigate factors associated with increased radiation exposure in fixation of proximal femur fractures.Methods: We assessed 369 neck of femur fractures over a 1-year period in a district general hospital. All hip fracture subtypes that had undergone surgical fixation were included. We assessed the relationship between type of fracture, implants used and surgeon level of experience with the dose-area product (DAP; cGy/cm2) and screening time (dS). We also looked at the quality of reduction and fixation and its effect on the radiation exposure.Results: A total of 184 patients were included in our analysis; 185 patients who were treated with hip arthroplasty were excluded. There was a significant association between higher DAP and fracture subtype (p = 0.001), fracture complexity (p < 0.001), if an additional implant was used (p = 0.001), if fixation was satisfactory (p = 0.002) and operative time (p < 0.001). DAP was higher with a proximal femoral nail than with a dynamic hip screw, especially when a long nail was used. There was some evidence of an association between the surgeon's level of experience and DAP exposure, although this was not statistically significant (p = 0.069).Conclusions: Increased radiation in proximal femur fractures is seen in the fixation of complex fractures, some subtypes, with certain types of implants used and if an additional implant was required. Surgeon seniority did not result in less radiation exposure, which is in contrast to other published studies.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"41-47"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term mental and physical quality of life outcomes following ileal pouch anal anastomosis surgery. 回肠袋肛门吻合术后的长期心理和生理生活质量。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-01-01 Epub Date: 2024-02-16 DOI: 10.1308/rcsann.2023.0075

M Abdalkoddus, J Franklyn, S Balasubramanya, F Parker, Z Zhao, W Douie, S Smolarek

{"title":"Long-term mental and physical quality of life outcomes following ileal pouch anal anastomosis surgery.","authors":"M Abdalkoddus, J Franklyn, S Balasubramanya, F Parker, Z Zhao, W Douie, S Smolarek","doi":"10.1308/rcsann.2023.0075","DOIUrl":"10.1308/rcsann.2023.0075","url":null,"abstract":"Introduction: This study presents the authors' experience over 14 years of performing restorative procto-colectomy with ileal pouch anal anastomosis (IPAA). The aim was to study the long-term quality of life outcomes and analyse the predictors of pouch function as well as physical and mental wellbeing.Methods: This is a single-centre retrospective study conducted in a specialised colorectal surgery unit in the UK. The study included patients who underwent two- or three-staged panproctocolectomy with defunctioning ileostomy for ulcerative colitis (UC) or familial adenomatous polyposis between 2004 and 2018. Data were collected from a prospectively, surgeon-maintained database. Pouch function and quality of life scores were obtained via validated questionnaires. A multivariate analysis was utilised to explore predictors of quality of life and pouch function.Results: The study reports 105 patients who underwent IPAA with a covering ileostomy. The majority of operations were performed for UC (97, 92.4%). The median age of patients was 36 years and the male to female ratio was 1:1. Thirty patients (28.5%) suffered early post-IPAA complications, while pouch failure rate was 11.4% (12/105). Late complications were reported at a rate of 45%. On long-term follow-up, the median Pouch Function Score was 7 (IQR 3-14). Both the physical and mental sections of the quality of life score were at a median indistinguishable from the normal population but had different predictors associated with them.Conclusion: Our findings recognise the complex interplay between physical and psychological wellbeing after pouch surgery and advise psychological counselling where appropriate.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"18-24"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139740232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The 'Wirral Wedge': an aid to position arm safely in upper limb surgery. 威勒尔楔子"：上肢手术中安全定位手臂的辅助工具。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-01-01 Epub Date: 2024-04-02 DOI: 10.1308/rcsann.2023.0103

J Russell, J Holt, R Chandrasekar

引用次数: 0

A systematic review of the prevalence of burnout in orthopaedic surgeons. 矫形外科医生职业倦怠发生率的系统回顾。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-01-01 Epub Date: 2024-04-02 DOI: 10.1308/rcsann.2024.0009

K Chahal, K Matwala

{"title":"A systematic review of the prevalence of burnout in orthopaedic surgeons.","authors":"K Chahal, K Matwala","doi":"10.1308/rcsann.2024.0009","DOIUrl":"10.1308/rcsann.2024.0009","url":null,"abstract":"Introduction: Professional burnout is a syndrome of emotional exhaustion, depersonalisation and low sense of personal achievement related to the workplace. Orthopaedic surgeons train and practise in highly demanding environments. Understanding up-to-date trends in burnout, particularly following the COVID-19 pandemic, is vital. For this reason, we carried out a systematic review on this topic.Methods: A scoping literature review of two databases was conducted. Two authors independently screened articles and conflicts were resolved by panel discussion. Articles pertaining to orthopaedic surgeons that used validated scales and were peer reviewed research were included. Non-English or abstract-only results were excluded.Results: A total of 664 papers were identified in the literature search and 34 were included in the qualitative review. Among 8,471 orthopaedic surgeons, the mean burnout prevalence was 48.9%. The wide range in rate of burnout between the studies (15-90.4%) reflected the variety in setting, subspecialty and surgeon grade. Common protective factors comprised dedicated mentorship, surgeon seniority, sufficient exercise and family support. Substance abuse, malpractice claims, financial stress and onerous on-call responsibilities were risk factors. Burnout prevalence during the COVID-19 pandemic was not noticeably different; there were a number of pandemic-associated risk and protective factors.Conclusions: Nearly one in two orthopaedic surgeons are burnt out. There is a paucity of data on the short and long-term impact of COVID-19 on burnout. Burnout has deep organisational, personal and clinical implications. Targeted organisational interventions are required to prevent burnout from irrevocably damaging the future of orthopaedic surgery.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"61-67"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A thank you to all our reviewers. 感谢我们所有的评论者。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-01-01 DOI: 10.1308/rcsann.2024.0116

引用次数: 0

A novel adaption to suction-assisted seroma aspiration. 对抽吸辅助血清肿抽吸术进行了新的调整。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-11-21 DOI: 10.1308/rcsann.2024.0068

M A Langford, W Chow, P Kalu, J Birch

引用次数: 0

Enhancing vascular surgery outcomes through geriatric co-management: a study on the impact of the POPS team. 通过老年病共同管理提高血管外科手术疗效：关于 POPS 团队影响的研究。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-11-12 DOI: 10.1308/rcsann.2024.0084

Mea Bakheet, M Hughes, N Darwish, S Chen, A Egun, M Banihani

{"title":"Enhancing vascular surgery outcomes through geriatric co-management: a study on the impact of the POPS team.","authors":"Mea Bakheet, M Hughes, N Darwish, S Chen, A Egun, M Banihani","doi":"10.1308/rcsann.2024.0084","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0084","url":null,"abstract":"Introduction: Peripheral arterial disease (PAD) involves atherosclerotic stenosis and occlusion of lower leg arteries, leading to significant disability, high cardiovascular and cerebrovascular morbidity and mortality. Critical limb ischemia (CLI) is the most severe form of PAD. With the UK's aging population set to increase, the prevalence of PAD and the burden on vascular teams are expected to rise. This study evaluates the impact of regular input from the Proactive Care of Older People Undergoing Surgery (POPS) team on vascular surgery outcomes.Methods: This prospective cohort study examined the impact of Care of the Elderly (CoE) input on predefined parameters, focussing primarily on the length of stay (LoS) over 12 months. Data included baseline demographics, comorbidities, frailty scores (assessed using the Rockwood frailty score), LoS and referrals to medical specialties. A retrospective pilot study of 50 consecutive patients indicated a need for CoE input, showing higher local LoS compared with the national average.Results: Patients in both pilot and project groups were matched for comorbidities, frailty scores and interventions. Despite higher mean age and a greater proportion of patients aged 75+ years in the project group, the study aimed to reduce LoS. Post-quality improvement project implementation, LoS beyond fit-for-discharge decreased from 11.7 days to 9 days in 6 months and to 6 days after 12 months. Referrals to medical specialties decreased from 77% to 40%, and new diagnoses on discharge increased from 28% to 37%.Conclusions: CoE team input in vascular surgery patient care significantly improved outcomes, reducing LoS and medical specialty referrals, demonstrating cost-effectiveness and suggesting a feasible multidisciplinary approach for other regions.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613756","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}

引用次数: 0

The 2-week wait pathway for suspected head and neck cancers in patients with throat and voice symptoms: referral patterns, common clinical practice and diagnostic efficacy of NICE guidelines. 咽喉和嗓音症状患者疑似头颈部癌症的 2 周等待路径：NICE 指南的转诊模式、常见临床实践和诊断效果。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-11-12 DOI: 10.1308/rcsann.2024.0072

F A Chiumenti, A L Pendolino, F M Vaz, R C Dwivedi

{"title":"The 2-week wait pathway for suspected head and neck cancers in patients with throat and voice symptoms: referral patterns, common clinical practice and diagnostic efficacy of NICE guidelines.","authors":"F A Chiumenti, A L Pendolino, F M Vaz, R C Dwivedi","doi":"10.1308/rcsann.2024.0072","DOIUrl":"10.1308/rcsann.2024.0072","url":null,"abstract":"Introduction: The 2-week wait (2ww) referral pathway has been introduced into UK clinical practice to increase the early detection of cancer and improve survivals. The efficiency of this system for head and neck (H&N) cancers has been questioned over the years because of evidence of low pick-up rates. H&N cancers present with a wide variety of non-specific symptoms, particularly throat and voice symptoms. These symptoms need to be accurately interpreted together with risk factors if they are to be addressed adequately and overload of cancer facilities avoided. One of the most common outcomes of H&N 2ww referrals is laryngopharyngeal reflux (LPR), a common condition that could be diagnosed and managed in the primary care setting with a prescription of proton pump inhibitors (PPI) trials.Methods: We retrospectively analysed a cohort of consecutive patients referred on the 2ww pathway for throat and voice symptoms at University College London Hospital H&N cancer clinic during two months in 2019.Results: A total of 101 patients (43.6% men, mean age 53.3 years) were included. Throat and voice symptoms were described as intermittent in 52.5% and non-lateralised in 88.1%. Diagnosis of LPR was made in 59.4% of the referrals. A PPI trial was prescribed by general practitioners (GPs) in only 7.9% of cases. The cancer pick-up rate in our cohort is 2.9%.Conclusions: An improved awareness of the symptoms of LPR could guide GPs to prescribe trials of PPIs in low-risk patients before rushing into a referral on a cancer pathway. This would improve the 2ww process on many levels, reduce the burden on the National Health Service and avoid patients' psychological distress.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613763","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}

引用次数: 0

Innovation and the publishing gambit. 创新和出版赌局。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-11-01 DOI: 10.1308/rcsann.2024.0102

B Rogers

引用次数: 0