Annals of the Royal College of Surgeons of England最新文献_第5页

Decision making and outcomes in colorectal cancer and frailty: the DeCaF study. 结直肠癌和虚弱的决策和结果：DeCaF研究。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0050

A Kler, J Tay, C Slawinski, C Welch, S Moug, S Blackwell, R Arnott, P Mitchell, N Heywood

{"title":"Decision making and outcomes in colorectal cancer and frailty: the DeCaF study.","authors":"A Kler, J Tay, C Slawinski, C Welch, S Moug, S Blackwell, R Arnott, P Mitchell, N Heywood","doi":"10.1308/rcsann.2025.0050","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0050","url":null,"abstract":"Introduction: Surgical resection is the main treatment for non-metastatic colorectal cancer (CRC). However, 6% of patients do not undergo surgery owing to frailty, according to the National Bowel Cancer Audit (NBOCA). The impact of preoperative evaluation and decision making on outcomes in frail patients is underexplored. This study examines variation in decision making for frail, older patients and the availability/use of resources by colorectal multidisciplinary teams (MDTs) across United Kingdom (UK) hospitals.Methods: A UK-wide questionnaire was distributed to colorectal MDTs via the NBOCA newsletter and social media (18 May to 30 June 2021). Part A assessed MDT structure and resource use; Part B explored MDT decisions for two simulated 75-year-old patients with colonic and rectal cancer.Results: Twenty MDTs responded. Decisions were MDT-driven in 55% (n = 11) and surgeon-driven in 45% (n = 9). Clinical examination (85%) and performance status (90%) were most used. Resource utilisation during MDT meetings varied across sites; for example, echocardiogram results were available and considered in MDT decision making in only 15% of centres. Cardiopulmonary exercise testing was used in 75%, anaesthetic assessment in 80%, frailty scoring in 25%, and preoperative geriatric assessment in 5%. Management of right-sided cancer was more consistent; rectal cancer decisions were more variable.Conclusions: Variation exists across MDTs in the availability and use of resources when managing frail CRC patients. There is less consensus for rectal than caecal cancer. These findings highlight the need for standardised MDT protocols to support equitable, patient-centred care in complex cases.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636017","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 Birmingham Mandible and Mid-face (BruMM) rules: interim data analysis. 伯明翰下颌和中脸（BruMM）规则：中期数据分析。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2024.0107

Roc Elledge, S Vatharkar, D McNulty, D Parekh

{"title":"The Birmingham Mandible and Mid-face (BruMM) rules: interim data analysis.","authors":"Roc Elledge, S Vatharkar, D McNulty, D Parekh","doi":"10.1308/rcsann.2024.0107","DOIUrl":"10.1308/rcsann.2024.0107","url":null,"abstract":"Introduction: Clinical predictor rules are useful heuristics that can inspire confidence in clinicians on the front line to make decisions that are safe and reproducible. Rules such as the Ottawa Ankle Rules can also reduce the number of unnecessary radiographs taken, reducing radiation exposure and cost, as well as improving quality of care.Methods: A previous Delphi study delineated 11 variables associated with an increased likelihood of finding a mandibular fracture and 14 variables associated with an increased likelihood of finding a zygomatic fracture on plain film radiographs. In the current study, clinicians suspecting a mandibular and/or zygomatic fracture were invited to complete a proforma identifying any of these variables in advance of requesting plain film radiograph(s). An interim analysis was conducted with predictors being cross-tabulated against relevant outcomes using: sensitivity, specificity, Jaccard index, odds ratio (OR) and Fisher's exact probability.Results: During the period January to October 2022 inclusive, 69 records were inputted into REDCap, of which 20/69 demonstrated a fracture. Fisher's exact test produced several significant results including malocclusion (p<0.0001, OR 31.99), presence of a new open bite (p<0.001, OR undefined) and subconjunctival haemorrhage (p<0.05, OR undefined).Conclusions: Data collection is continuing and initial interim analysis would suggest a sample size of n=252 will be required, assuming a negative scan rate of 55%, to achieve a specificity of 0.90 within ±0.05. We aim to present finalised data in 2025.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636034","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

Calcific tendonitis of the shoulder; when should we operate? 肩部钙化性肌腱炎；我们应该什么时候动手术？

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0046

T Berg, J M Bentley, N Saravanan, H Morris, A P Dekker, D I Clark

{"title":"Calcific tendonitis of the shoulder; when should we operate?","authors":"T Berg, J M Bentley, N Saravanan, H Morris, A P Dekker, D I Clark","doi":"10.1308/rcsann.2025.0046","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0046","url":null,"abstract":"Introduction: This study aimed to determine patient factors associated with the failure of nonoperative management of calcific tendonitis and subsequent operative intervention. The secondary aim was to assess whether the size of the calcific deposit can determine the need for surgery, as shown by previous studies in the literature.Methods: A retrospective review of a prospectively maintained database of a consecutive series of patients diagnosed with calcific tendonitis attending a single hospital trust orthopaedic department between 2014 and 2018 was performed. Data were collected on the size and location of the calcium deposit, comorbidities, Oxford Shoulder Score and functional range of movement.Results: A total of 61 patients were included. Factors associated with the failure of nonoperative management were: size of calcific deposit >10mm (p=0.009), female sex (p=0.005), a chronic condition of more than eight months duration (p=0.001), failed previous treatment (still symptomatic after previous management, requiring treatment) (p=0.001) and patients for whom steroid injections did not control their symptoms (p=0.02).Conclusions: Patients with a calcific deposit larger than 10mm, who are female, or have had symptoms for more than eight months are more likely to require surgery. Those with a transient response to steroid injections and or physiotherapy are also more likely to require surgical management.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636015","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

Optimising same day discharge hemithyroidectomy: defining outcomes, unplanned admissions and patient experience. 优化当天出院半甲状腺切除术：确定结果，非计划入院和患者体验。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0049

W MacFaul, M Wojtowicz, B Puttergill, A McLaren

{"title":"Optimising same day discharge hemithyroidectomy: defining outcomes, unplanned admissions and patient experience.","authors":"W MacFaul, M Wojtowicz, B Puttergill, A McLaren","doi":"10.1308/rcsann.2025.0049","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0049","url":null,"abstract":"Background: There is increasing emphasis on day-case hemithyroidectomy in the UK, with the national NHS/Get-it-right-first-time (GIRFT) recommending 30% zero-night stay rate. Buckinghamshire Healthcare Trust currently achieves >70% zero-night stay rate. This study profiles successfully treated day-case patients, evaluates reasons for unplanned admissions, complication rates and patient satisfaction, offering insights for units seeking to expand day-case practice.Methods: This is a retrospective cohort review from 2020 to 2024 of patients undergoing hemithyroidectomy treated by two surgeons: one with over a decade of day-case experience and one adopting the practice in 2021.Results: Of 336 patients (mean age 51±15 years, male:female 1:4), 283 (84%) were discharged on the same day with planned overnight admissions (37 patients, 11%) were primarily older (62 versus 50 years, p<0.05), more often American Society of Anesthesiologists (ASA) grade 3 (p=0.05), with a trend towards larger gland size, without correlation in either group to surgeon experience. Reasons for unplanned admissions in 14 patients (4%) were: anaesthetic concerns (n=3), intraoperative bleeding (n=2), large glands (n=2) and combined others, with all stays <48h. There was no correlation between unplanned admissions and patient age, ASA status or surgical indication. No hemithyroidectomy resulted in postoperative neck hemorrhage or return to theatre. More than 80% of patients surveyed would choose same-day discharge hemithyroidectomy over an inpatient stay, with all of respondents reporting adequate pain control.Conclusions: With robust protocols and appropriate patient selection, high rates of day-case hemithyroidectomy are achievable, in alignment with a high rate of patient satisfaction. Unexpected admissions lack clear predictors.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636019","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

Small bowel herniation through the epiploic foramen reduced laparoscopically. 经大网膜孔的小肠疝腹腔镜复位。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0053

S Bhattacharyya, M Bassuni

引用次数: 0

Patients' priorities in kidney stone disease. 肾结石患者优先考虑的问题。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0051

V Popoola, G Wheeler, S A Howles, C E Lovegrove

{"title":"Patients' priorities in kidney stone disease.","authors":"V Popoola, G Wheeler, S A Howles, C E Lovegrove","doi":"10.1308/rcsann.2025.0051","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0051","url":null,"abstract":"Introduction: Engaging with patients and the public is essential to design and deliver impactful research. Enhancing the relevance of research and tailoring treatments to align with patients' preferences can facilitate improved clinical care.Methods: We aimed to identify the research, support and treatment priorities of individuals with kidney stone disease (KSD) using a 25-question survey in inpatient and outpatient urology departments.Results: Forty-four individuals with KSD responded to our survey; 28 (64%) had experienced multiple KSD episodes and 11 reported 5 or more episodes. Median self-rated quality-of-life (QoL) impact (0 = negligible; 10 = severe) was 7.00 out of 10.00 (interquartile range [IQR]: 5.00-9.00), equivalent in individuals with single and recurrent stone episodes. Pain (n = 34), haematuria (n = 28) and anxiety (n = 22) were the primary factors contributing to QoL impact. Participants prioritised research into preventing recurrence, alleviating pain and slowing stone growth. More than one-third desired more information about KSD. Most (n = 36) felt 'likely' or 'very likely' to take medication to reduce their risk of KSD and 25 would commit to life-long therapy. Daily dosing was acceptable to 13 participants if risk of KSD recurrence was reduced by 50%, rising to 34 respondents if risk of recurrence was reduced by 75%. Most respondents (n = 44) expressed willingness to have genetic testing to facilitate personalised medicine research.Conclusions: Our findings emphasise symptoms contributing to reduced physical and psychological wellbeing in patients with KSD. We highlight the need for research into developing therapies to prevent stone recurrence, alleviate pain and slow stone growth, and for educational materials. Responses indicate an appetite for personalised medicine and oral medications in KSD.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636032","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

Cholecysto-duodenal and cholecysto-colic fistulae identified intraoperatively during laparoscopic cholecystectomy in a surgical hub. 腹腔镜胆囊切除术术中发现胆囊十二指肠瘘和胆囊结肠瘘。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0054

C R Smith, A Valnarov-Boulter, R Kerwat

引用次数: 0

Comparison of orthopaedic specialty registrar training opportunities in trusts with and without an elective surgical hub: a review of administrative data. 有和没有选择性外科中心的信托医院骨科专科注册医师培训机会的比较：对行政数据的回顾。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-11 DOI: 10.1308/rcsann.2024.0085

E O Ojelade, W K Gray, Twr Briggs

{"title":"Comparison of orthopaedic specialty registrar training opportunities in trusts with and without an elective surgical hub: a review of administrative data.","authors":"E O Ojelade, W K Gray, Twr Briggs","doi":"10.1308/rcsann.2024.0085","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0085","url":null,"abstract":"Introduction: During the COVID-19 pandemic in England, orthopaedic surgery trainees experienced a reduction in training opportunities due to periods of elective surgery suspension. We aimed to explore training opportunities for orthopaedic trainees in trusts with and without access to an elective surgical hub.Methods: This retrospective analysis of administrative data used eLogbook data for registrars who performed six high-volume, low-complexity orthopaedic procedures in NHS hospitals in England between April 2017 and March 2023. Data included training grade, role in the procedure, trust where the procedure was performed and procedure date. These were linked to Hospital Episodes Statistics (HES) data on the total number of these procedures conducted during the study period and whether the trust hosted or fed into an elective surgical hub at the time of the procedure.Results: Data were analysed for 1,755 trainees acting as first surgeon in 125,759 procedures. Trusts with access to an elective surgical hub significantly increased the proportion of procedures conducted by a trainee compared with non-hub trusts over the study period. Most of the increase in trainee involvement was associated with more senior trainees (ST6-8). The proportional increase was not enough to offset the decline in the absolute number of procedures conducted by trainees (25,598 (2017-2018), 21,057 (2022-2023)).Conclusions: Elective surgical hubs have made a positive contribution to training opportunities for orthopaedic trainees but not enough to offset the post-pandemic fall in activity. The number of procedures conducted in NHS hospitals and the rate of training opportunities must be increased.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607233","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

Identifying functional cortical plasticity after spinal tumour resection using navigated transcranial magnetic stimulation. 利用导航经颅磁刺激识别脊柱肿瘤切除术后的皮质功能可塑性。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-01 Epub Date: 2024-07-04 DOI: 10.1308/rcsann.2024.0040

L Onyiriuka, J M Aliaga-Arias, S Patel, A Khan, K Ashkan, R Gullan, R Bhangoo, A Ahmed, G Grahovac, F Vergani, A Kailaya-Vasan, J P Lavrador

{"title":"Identifying functional cortical plasticity after spinal tumour resection using navigated transcranial magnetic stimulation.","authors":"L Onyiriuka, J M Aliaga-Arias, S Patel, A Khan, K Ashkan, R Gullan, R Bhangoo, A Ahmed, G Grahovac, F Vergani, A Kailaya-Vasan, J P Lavrador","doi":"10.1308/rcsann.2024.0040","DOIUrl":"10.1308/rcsann.2024.0040","url":null,"abstract":"Our aim was to investigate the effectiveness of navigated transcranial magnetic stimulation (nTMS) brain mapping to characterise preoperative motor impairment caused by an intradural extramedullary (IDEM) tumour and postoperative cortical functional reorganisation. Preoperative and 1-year follow-up clinical, radiological and nTMS data from a case of thoracic spinal meningioma that underwent surgical resection of the lesion were collected and compared. A 67-year-old patient presented with severe progressive thoracic myelopathy (hypertonic paraparesis, clonus, insensate urinary retention) secondary to an IDEM tumour. Initial nTMS assessment showed bilateral upper limb representation with no positive responses for both lower limbs. He underwent successful surgical resection for his IDEM (meningioma WHO grade 1). At 1-year follow-up, the patient's gait was improved and his bladder function normalised. nTMS documented positive responses for both upper and lower limbs and a decrease in the area (right side: 1.01 vs 0.39cm2; left side: 1.92 vs 0.81cm2) and volume (right side: 344.2 vs 42.4uVcm2; left side: 467.1 vs 119uVcm2) of cortical activation for both upper limbs, suggesting a functional reorganisation of the motor areas after tumour resection. nTMS motor mapping and derived metrics can characterise preoperative motor deficit and cortical plasticity during follow-up after IDEM resection.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"446-450"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496880","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 review of the Masquelet technique in the treatment of lower limb critical-size bone defects. Masquelet技术治疗下肢临界骨缺损的研究进展。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-01 Epub Date: 2023-06-27 DOI: 10.1308/rcsann.2023.0022

H Ahmed, M Shakshak, A Trompeter

引用次数: 0