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

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

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.

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

The acute management of Pilon fractures (ENFORCE) study: a national evaluation of practice. Pilon骨折的急性治疗（enforcement）研究：一项全国评估实践。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-12-13 DOI: 10.1308/rcsann.2024.0063

D S Hill, J R Davis

{"title":"The acute management of Pilon fractures (ENFORCE) study: a national evaluation of practice.","authors":"D S Hill, J R Davis","doi":"10.1308/rcsann.2024.0063","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0063","url":null,"abstract":"Introduction: Pilon fractures are potentially limb-threating injuries. Staged soft tissue damage control is described, but actual practices are unknown. We report a national trainee collaborative evaluating how tibial Pilon fractures are acutely managed.Methods: ENFORCE was a multicentre retrospective observational study of the acute management of tibial Pilon fractures over a three-year period. Mechanism of injury, imaging, fracture classification, time to cast application, soft tissue damage control strategy and definitive management details were determined.Results: A total of 656 patients (670 fractures) across 27 centres were reported. AO fracture classifications were: partial articular (n=294) and complete articular (n=376). Initial diagnostic imaging mobilities were plain radiographs (n=602) and a trauma computed tomography (CT) scan (n=54). A total of 526 fractures had a cast applied in the emergency department (91 before radiological diagnosis), with the times taken to obtain postcast imaging being: mean 2.7 hours, median 2.3 hours and range 28 minutes-14 hours. 35% (102/294) of partial articular and 57% (216/376) of complete articular fractures had a spanning external fixator applied, all of which underwent a planning CT scan. Definitive management consisted of open reduction internal fixation (n=495), fine wire frame (n=86), spanning external fixator (n=25), intramedullary nail (n=25) or other (n=18).Conclusion: The management of tibial Pilon fractures is variable, with just over half of complete articular fractures managed with the gold standard 'span, scan, plan' staged soft tissue resuscitation. A national standard of care would increase the profile and standardise management of these potentially limb-threatening injuries, together with setting them apart from more straightforward ankle fractures.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816894","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

A national survey of the provision of prehabilitation for oesophagogastric cancer patients in the UK. 英国食道胃癌患者预康复服务全国调查。

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.2024.0092

S Barman, R C Walker, P P Pucher, S Jack, G Whyte, Mpw Grocott, M West, N Maynard, T Underwood, J Gossage, A Davies

{"title":"A national survey of the provision of prehabilitation for oesophagogastric cancer patients in the UK.","authors":"S Barman, R C Walker, P P Pucher, S Jack, G Whyte, Mpw Grocott, M West, N Maynard, T Underwood, J Gossage, A Davies","doi":"10.1308/rcsann.2024.0092","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0092","url":null,"abstract":"Introduction: Studies have demonstrated that prehabilitation in oesophagogastric cancer (OGC) improves body composition, physical fitness and quality of life, and can reduce surgical complications. However, it is not offered in all OGC centres. Furthermore, definitions, funding and access to services vary. We conducted a survey of prehabilitation in OGC centres in England and Wales.Methods: OGC centres were identified through the National Oesophago-Gastric Cancer Audit (NOGCA). Survey questions were developed, piloted in two institutions and distributed via email in October 2022. Reminder emails were sent over two months until the survey closed in December 2022.Results: Responses were received from 28 of 36 centres. There was near-universal agreement that prehabilitation should be considered standard of care for patients on curative pathways (27/28; 96%). Most centres (21/28; 75%) offered prehabilitation. The majority of respondents believed that prehabilitation should commence at diagnosis (27/28; 96%) and consist of at least aerobic training and dietitian input. Most (26/28; 93%) believed access to clinical psychologists should be included; however, only 12 (43%) had access to clinical psychologists. Respondents believed prehabilitation improves quality of life (26/28; 93%), fitness (26/28; 93%), smoking cessation (28/28; 100%), surgical complication rates (25/28; 89.3%), likelihood of proceeding to surgery (25/28; 89.3%) and overall survival (20/28; 71.4%).Conclusions: Despite barriers to funding and a lack of best practice guidelines, most units deliver prehabilitation. Units require higher quality evidence, consensus on the most important aspects of the intervention and core outcome sets to support the delivery of services and facilitate audit to assess the impact of their introduction.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680687","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

Changes in hip and knee arthroplasty practice post-COVID-19 in the English NHS: a retrospective analysis of hospital episode statistics data. 英国国家医疗服务体系（NHS）COVID-19 后髋关节和膝关节置换术实践的变化：对医院发作统计数据的回顾性分析。

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.2024.0100

T W Wainwright, T Immins, R G Middleton

{"title":"Changes in hip and knee arthroplasty practice post-COVID-19 in the English NHS: a retrospective analysis of hospital episode statistics data.","authors":"T W Wainwright, T Immins, R G Middleton","doi":"10.1308/rcsann.2024.0100","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0100","url":null,"abstract":"Background: The COVID-19 pandemic significantly reduced hip and knee arthroplasty surgeries across the English NHS. With the resumption of regular operations postpandemic, efforts have been made to address the surgical backlog by maximising capacity. This study assesses the current activity rates of hip and knee arthroplasty in the NHS and their return to prepandemic levels.Methods: We analysed hospital episode statistics from all English NHS providers of hip and knee arthroplasty from 1 April 2018 to 31 March 2023. Variables such as activity, location of surgery, length of stay and readmission rates were examined.Results: Data for 706,772 hip and knee arthroplasty surgeries show that overall activity from 1 April 2022 to 31 March 2023 has decreased by 8.8% compared with the initial year of the study. During the last year, 38.4% of surgeries were performed in the independent sector, an increase from 29.6% in the first year.Discussion: The postpandemic recovery phase has seen a strategic shift of surgeries to the independent sector, which helps reduce backlogs but poses risks to the role of the NHS in surgical training and innovation. This redistribution has immediate benefits for patient care but may impede trainee development and weaken research capabilities due to the lack of infrastructure in independent sectors. To maintain its leading role in orthopaedic care, the NHS needs to explore innovative solutions and strategic partnerships, incorporating advanced technologies and new training methods to adapt to the evolving healthcare landscape.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680673","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

A case report and systematic review of periorbital emphysema following nose blowing or sneezing. 关于擤鼻涕或打喷嚏后眼眶周围气肿的病例报告和系统回顾。

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.2024.0090

S Salar, O Edafe

引用次数: 0

The risk of revision surgery after trainee-led primary total hip replacement. 受训者主导的初级全髋关节置换术后的翻修手术风险。

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.2024.0049

D J Howgate, P Garfjeld Roberts, A Palmer, A Price, A Taylor, J L Rees, B Kendrick

{"title":"The risk of revision surgery after trainee-led primary total hip replacement.","authors":"D J Howgate, P Garfjeld Roberts, A Palmer, A Price, A Taylor, J L Rees, B Kendrick","doi":"10.1308/rcsann.2024.0049","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0049","url":null,"abstract":"Introduction: The aim of this study was to determine the impact of operating surgeon grade and level of supervision on the incidence of one-year patient mortality and all-cause revision following elective primary total hip replacement (THR).Methods: National Joint Registry data from 2005 to 2020 for a single University Teaching Hospital were used, with analysis performed on the 15-year dataset divided into 5-year block periods (B1, 2005-2010; B2, 2010-2015; B3, 2015-2020). Outcome measures were mortality and revision surgery at one year, in relation to lead surgeon grade, and level of supervision for trainee-led (TL) operations.Results: A total of 9,999 eligible primary THRs were performed, of which 5,526 (55.3%) were consultant-led (CL), and 4,473 (44.7%) TL. Of TL, 2,404 (53.7%) were nonconsultant-supervised (TU) and 2,069 (46.3%) consultant-supervised (TS). The incidence of one-year patient mortality was 2.05% (n=205), and all-cause revision was 1.11% (n=111). There was no difference in one-year mortality between TL and CL operations (p=0.20, odds ratio (OR) 0.78, confidence interval (CI) 0.55-1.10). The incidence of one-year revision was not different for TL and CL operations (p=0.15, OR 1.37, CI 0.89-2.09). Overall, there was no temporal change for either outcome measure between TL or CL operations. A significant increase in revision within one-year was observed in B3 between TU compared with CL operations (p=0.005, OR 2.81, CI 1.35-5.87).Conclusions: We found no difference in overall one-year mortality or all-cause revision rate between TL and CL primary THR. Despite a reduction in unsupervised THR in the latest five-year period (2015-2020), unsupervised TL THR resulted in an increased risk of early revision.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680675","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

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