Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 2016
An intraoperative irrigation regimen to reduce the surgical site infection rate following adolescent idiopathic scoliosis surgery.
The aim of this study was to compare the efficacy of a gentamicin antibiotic intraoperative irrigation regimen (regimen A) with a povidone-iodine intraoperative irrigation regimen (regimen B) and to evaluate the ability of adjunctive local vancomycin powder (regimen C) to reduce the surgical site infection (SSI) rate following idiopathic scoliosis correction. ⋯ Wound irrigation with a povidone-iodine solution reduces SSIs following adolescent idiopathic scoliosis surgery. The direct application of vancomycin powder to the wound is safe but does not reduce the SSI rate further in low risk patients. Additional studies are needed to elucidate whether it is effective at higher doses and in high risk patient groups.
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Ann R Coll Surg Engl · Mar 2016
ReviewFrailty and cognitive impairment: Unique challenges in the older emergency surgical patient.
Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. ⋯ Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.
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Ann R Coll Surg Engl · Mar 2016
Safe management of paediatric penetrating head injury without a CT scanner: A strategy for humanitarian surgeons based on experience in southern Afghanistan.
In many parts of the world, access to a CT scanner remains almost non-existent, and patients with a head injury are managed expectantly, often with poor results. Recent military medical experience in southern Afghanistan using a well-equipped surgical facility with a CT scanner has provided new insights into safe surgical practice in resource-poor environments. ⋯ In resource-poor environments, clinically-based criteria may be used as a safe and appropriate strategy for selecting children who may benefit from relatively straightforward surgery after penetrating brain injury.
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Ann R Coll Surg Engl · Feb 2016
Best practices for scholarly authors in the age of predatory journals.
'Continuous effort, not strength or intelligence, is the key to understanding our potential.' Margaret J Wheatley. The focus of any academic or research author is to share his or her findings, and to gain respect and reward for publishing. The ideal journal is one that not only publishes an article quickly but also helps the author to improve the article before publication through peer review, selects only the best research so that the author's article lies alongside other high quality articles, and provides maximum (and long-term) visibility and access to the article. ⋯ Check. Submit. (http://thinkchecksubmit.org/), was launched in the latter half of 2015 and hopes to raise awareness of disreputable journals while clearly separating them from valid, high quality, open access journals (of which there are many). PIPPA SMART Guest Editor.
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Ann R Coll Surg Engl · Feb 2016
Decision making on timing of surgery for hip fracture patients on clopidogrel.
Patients taking clopidogrel who sustain a fractured neck of femur pose a challenge to orthopaedic surgeons. The aim of this study was to determine whether delay to theatre for these patients affects drop in haemoglobin levels, need for blood transfusion, length of hospital stay and 30-day mortality. A retrospective review of all neck of femur patients admitted at two centres in the North East of England over 3 years revealed 85 patients. ⋯ There were no significant differences in mortality or wound complications. Hip fracture patients on clopidogrel can be safely operated on early provided they are medically stable. Bleeding risk should be borne in mind in those patients on dual therapy with aspirin.