International journal of surgery
-
It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or 'tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs. ⋯ There is an increasing drive to improve the clinical role of the MDT within cancer care. This study demonstrates the main barriers that MDTs face in deciding on and, importantly, implementing a management plan. Further research should prospectively evaluate interventions to enhance translation of MDT decision-making into cancer care and thus to expedite and improve care.
-
Meta Analysis
Safety and impact on diagnostic accuracy of early analgesia in suspected acute appendicitis: a meta-analysis.
The safety of early analgesia in patients suspected to have acute appendicitis (AA) is still controversial. ⋯ Early analgesia with opiates in suspected AA might influence the approach to treatment, but does not appear to alter diagnostic accuracy or surgical outcome. To support our findings, further trials on larger sample sizes from different age groups and both genders are needed.
-
Chronic pelvic pain (CPP), a common gynaecological presentation, may be due to bladder pain syndrome (BPS) or the co-existence of BPS and endometriosis, known as the 'evil twins syndrome'. ⋯ Almost two thirds of women presenting with CPP have BPS. Large variations in prevalence may be due to variable study selection and quality. Clinicians need to actively investigate patients for BPS, a condition that appears to co-exist with endometriosis.
-
Delirium is highly prevalent, occurring in 20% of acute hospital inpatients and up to 62% of surgical patients. It is a significant predictor of poor outcomes including mortality and institutionalisation, however it is often viewed as simply a marker of underlying illness and is frequently overlooked in older adults. Although delirium is commonly comorbid with dementia, it represents a more urgent diagnosis, requiring prompt intervention. ⋯ Appropriate treatment of delirium requires thorough investigation, management of the underlying illness, avoidance of complications and simplification of the care environment. Studies suggest a role for pharmacological prophylaxis, particularly in relation to anaesthetic and sedative agents used intra- and post-operatively. Furthermore, gathering evidence suggests that judicious use of antipsychotic medications may be helpful in delirium prevention and treatment.
-
Laparoscopic correction of perforated peptic ulcer (PPU) has become an accepted way of management. Patch omentoplasty stayed for decades the main method of repair. The goal of the present study was to evaluate whether laparoscopic simple repair of PPU is as safe as patch omentoplasty. ⋯ Laparoscopic simple repair of PPU is a safe procedure compared with the traditional patch omentoplasty in presence of certain selection criteria.