The British journal of surgery
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Multicenter Study
Best-practice care pathway for improving management of mastitis and breast abscess.
Surgical subspecialization has resulted in mastitis and breast abscesses being managed with unnecessary admission to hospital, prolonged inpatient stay, variable antibiotic prescribing, incision and drainage rather than percutaneous aspiration, and loss to specialist follow-up. The objective was to evaluate a best-practice algorithm with the aim of improving management of mastitis and breast abscesses across a multisite NHS Trust. The focus was on uniformity of antibiotic prescribing, ultrasound assessment, admission rates, length of hospital stay, intervention by aspiration or incision and drainage, and specialist follow-up. ⋯ A standardized approach to mastitis and breast abscess reduced undesirable practice variation, with sustained improvements in process and patient outcomes.
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Pragmatic Clinical Trial
Effectiveness of a multidisciplinary patient care bundle for reducing surgical-site infections.
Surgical-site infection (SSI) is associated with significant healthcare costs. To reduce the high rate of SSI among patients undergoing colorectal surgery at a cancer centre, a comprehensive care bundle was implemented and its efficacy tested. ⋯ Meaningful reductions in SSI can be achieved by implementing a multidisciplinary care bundle at a hospital-wide level.
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Observational Study
Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer.
Evidence to support the specific use of magnetic resonance tumour regression grade (mrTRG) is inadequate. The aim of this study was to investigate the pathological characteristics of mrTRG after chemoradiotherapy (CRT) for rectal cancer and the implications for surgery. ⋯ Patients with mrTRG1 without tumour spread may be suitable for TAE.
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After neoadjuvant chemoradiotherapy (nCRT) plus surgery for oesophageal cancer, 29 per cent of patients have a pathologically complete response in the resection specimen. Active surveillance after nCRT (instead of standard oesophagectomy) may improve health-related quality of life (HRQoL), but patients need to undergo frequent diagnostic tests and it is unknown whether survival is worse than that after standard oesophagectomy. Factors that influence patients' preferences, and trade-offs that patients are willing to make in their choice between surgery and active surveillance were investigated here. ⋯ Patients are willing to trade off substantial 5-year survival to achieve a reduction in the risk that oesophagectomy is necessary.
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Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma.
The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. ⋯ Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.