Abstract:
INTRODUCTION:Accurate clinical diagnosis depends on the reliable recognition of signs and symptoms. This expertise comes from experience in seeing patients which has been traditionally gained over a long training period. Shortened specialist training (Modernising Medical Careers) has led to a greater reliance on structured teaching and skills transfer programmes. The accuracy of clinical diagnosis and the rate at which diagnostic skills improve during training is important for the assessment of trainees, and the delivery of care. PATIENTS AND METHODS:This study assessed the accuracy of clinical diagnosis of skin lesions by two junior plastic surgery trainees. They were asked to diagnose 120 consecutive skin lesions seen in a pigmented skin lesion clinic in 2005, with the histological diagnosis being confirmed following subsequent excision. The process was repeated a year later in 2006 to enable the rate of correct diagnosis to be compared. RESULTS:Initially, 53.3% of diagnoses were correct. A year later, this had risen to 65.0%. Twenty-two different skin pathologies were present in excised specimens, and skin cancers comprised 30%. The trainees demonstrated 93.8% sensitivity in their initial diagnosis of malignancy (95% CI, 79.2-99.2) and 97.4% a year later (95% CI, 86.5-99.9). However, specificity was 69.3% (95% CI, 58.6-78.7) in 2005 and 71.6% (95% CI, 60.5-71.4) in 2006. CONCLUSIONS:Accuracy in the diagnosis of the wide range of skin conditions presenting to an out-patient clinic was shown to increase over a 1-year period. We feel that this improvement resulted from regular clinical exposure supported by a structured learning programme. The shortening of the specialist training period may affect the acquisition of diagnostic skills by trainees and impact on the confidence with which they commence consultant practice.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Pearl RA,Townley W,Stott D,Grobbelaar AOdoi
10.1308/003588409X432112subject
Has Abstractpub_date
2009-09-01 00:00:00pages
494-9issue
6eissn
0035-8843issn
1478-7083pii
10752journal_volume
91pub_type
杂志文章abstract:INTRODUCTION:Ureteric stenting is a common urological procedure. Forgotten stents have a well-documented morbidity and mortality. Therefore, we asked the question, is a stent register an important factor in reducing the number of lost or overdue stents? PATIENTS AND METHODS:We conducted a retrospective review of 203 p...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588408X242123
更新日期:2008-03-01 00:00:00
abstract:INTRODUCTION:Most women who have screening mammography and undergo subsequent open biopsy following an indeterminate core biopsy result are eventually found to have benign disease. However, a significant number have malignant disease and the rate of malignancy in such cases may be influenced by various factors. This s...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588412X13171221498460
更新日期:2012-03-01 00:00:00
abstract:INTRODUCTION:Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. METHODS:The records of 60 consecutive referrals for incidental gallbladder cancer in a sin...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588414X14055925060073
更新日期:2015-03-01 00:00:00
abstract::Cutaneous manifestations of visceral carcinomas are scarce, occurring in around 0.7-12% of internal malignancies. Lung cancer is one of the most common sources of skin metastasis, particularly in male patients. We present a case of cutaneous metastasis in a man with concurrent lung lesions and a previously treated col...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0088
更新日期:2016-03-01 00:00:00
abstract::A 62-year old man who presented unwell with no specific symptoms or signs was found to have portal venous circulation gas complicating a small diverticular abscess. He was successfully managed with a course of antibiotics and had full resolution of symptoms, therefore avoiding the need for surgical intervention. While...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2020.0089
更新日期:2020-09-01 00:00:00
abstract::Rectus femoris origin injuries in adult athletes are uncommon. In the acute phase, conservative treatment seems to have a favourable outcome, with surgical repair reserved for unsuccessful cases only. However, a group of patients may develop chronic pain and disability after recovery from the acute phase due to heter...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588412X13171221589333
更新日期:2012-04-01 00:00:00
abstract::Aggressive angiomyxoma (AAM) was first reported in 1983 as a distinct, slow growing, benign but locally infiltrative, soft tissue tumour. It usually arises in the pelvic and perineal organs, mostly in women. A 47-year-old woman was found to have a large encapsulated retroperitoneal aggressive angiomyxoma. The mass was...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/14787080465
更新日期:2004-11-01 00:00:00
abstract::Six patients are reported who presented with perforated duodenal ulcers. These were repaired laparoscopically by suturing the falciform ligament over the perforated ulcer. There were no complications and patients were discharged between 3 and 5 days after surgery. This technique is simpler to perform than a laparoscop...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1996-07-01 00:00:00
abstract::Introduction A bronchobiliary fistula (BBF) following liver directed therapy (resection/ablation) is a rare complication in which an abnormal communication between the biliary tract and bronchial tree is formed. This case report describes the successful management of a persistent BBF following multiple liver wedge res...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2018.0026
更新日期:2018-04-01 00:00:00
abstract::Complex perianal fistulas may at times be very difficult to treat. New vascularised tissue can reach the perineum from leg muscles and the omentum. A less well-known source is the labial fat tissue (modified Martius graft) which has a robust posterolateral pedicle and which can be useful as an adjunctive technique for...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1998-11-01 00:00:00
abstract:OBJECTIVE:To assess the surgical workload on a renal unit, with particular reference to non-transplant-related surgery and to assess the workload in relation to surgical staffing levels. DESIGN:Prospective audit of all surgical procedures carried out on patients in acute or chronic renal failure, and on transplanted p...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00
abstract::We present a case of a chronic recurrent rectovaginal fistula that initially arose from complications of haemorrhoid surgery and had failed multiple prior surgical repairs. The fistula was successfully managed using viable cryopreserved placental tissue. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2017.0157
更新日期:2017-11-01 00:00:00
abstract::Congenital cholesteatoma is a rare entity. It arises from aberrant epithelial remnants left at the time of closure of the neural groove, between the 3rd and 5th week of embryonic life. Otoscopy typically shows a pearly white mass, medial to the intact tympanic membrane, primarily in the anterosuperior quadrant, withou...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/147870807X160425
更新日期:2007-03-01 00:00:00
abstract::Spontaneous rupture of colon or rectum is a rare event. Protrusion of several loops of small bowel through the anal orifice is a bizarre condition which has only rarely been reported in the literature. We report the first case where Thiersch repair was used to manage spontaneous perforation of rectal prolapse and prov...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/147870807X160362
更新日期:2007-01-01 00:00:00
abstract::Four cases of unilateral digital ischaemia in the upper limb secondary to embolisation from atheromatous plaques in the proximal subclavian artery are presented. Digital subtraction angiography or arch aortography were used to demonstrate the site of atheroma. In one case diagnostic delay resulted from failure to visu...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1989-03-01 00:00:00
abstract::A patient with phyllodes tumour of the breast is discussed. During follow-up, she presented with intestinal obstruction caused by ileocaecal intussusception. The cause of the intussusception was metastatic phyllodes tumour, which is a unique presentation. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/147870810X12699662981357
更新日期:2010-09-01 00:00:00
abstract::Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the lower limb. We describe the case of a 73-year-old woman with right knee pain for three weeks, a cellulitic right thigh and cholestatic liver function test...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2020.0137
更新日期:2020-11-01 00:00:00
abstract::We present the first reported case of a partial thickness burn to the skin from discarded bone cement during a routine total hip replacement (THR). The patient required plastic surgical attention for 5 months before the skin was healed. We summarise the reported incidents of cement burns to various other structures an...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588407X168262
更新日期:2007-03-01 00:00:00
abstract::The aims of this study were to identify prospectively 'concealed' postoperative problems, to assess the burden of paediatric day care surgery on primary care services and to define a normal recovery period for common children's procedures. At their first postoperative clinic visit, patients and parents were asked dire...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1999-05-01 00:00:00
abstract:INTRODUCTION:The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, a...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588409X359411
更新日期:2009-03-01 00:00:00
abstract::Introduction Venous thromboembolism (VTE) is a potentially fatal complication of hip arthroplasty and knee arthroplasty. The National Institute for Health and Care Excellence recommend rivaroxaban for VTE prevention. Amid concerns over bleeding complications, the modified thromboprophylaxis policy of Chelsea and Westm...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0197
更新日期:2016-09-01 00:00:00
abstract::Inflammatory fibroblastic tumours are very rare. They are mostly located in the respiratory system. We present three cases of patients with fibroblastic tumours. The diversity of inflammatory fibroblastic tumours in the respiratory system and the surgical considerations are discussed. Our recommendation is that treatm...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0033
更新日期:2016-01-01 00:00:00
abstract::Infection is an important arbiter of success or failure of surgical practice and the incidence of infection is incorporated into all surgical audit systems. If audit is to be of value the outcome end points of clinical practice must be defined. We have attempted to derive clinical definitions suitable for bedside diag...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 指南,杂志文章,实务指引
doi:
更新日期:1991-11-01 00:00:00
abstract:INTRODUCTION:The equivalence of breast-conserving surgery followed by postoperative radiotherapy against mastectomy is now firmly established in patients with early breast cancer. The results of surgery in large-breasted women can be poor, with radiation-induced fibrosis, chronic pain and poor cosmesis contributing to ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588413X13511609958091
更新日期:2013-04-01 00:00:00
abstract::The technique of selective arterial embolisation for patients presenting with major hepatic trauma is described. We have used this technique successfully in four patients, three of whom had continued bleeding after emergency laparotomy. It can abolish localised intrahepatic arterial haemorrhage and arteriovenous shunt...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1991-05-01 00:00:00
abstract::The prevalence of HIV in the UK has been estimated to be 1 in 1000 of the population. Surgeons are at particular risk of occupational transmission from infected blood. To determine the effect of HIV on surgical practice we sent a questionnaire to 681 general surgeons in England and Wales; 450 replied (66%). Of those w...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1990-09-01 00:00:00
abstract::Introduction Procedure specific consent forms (PSCFs) have been shown to improve consenting practice for a standardised list of complications. The aim of this study was to assess the current usage and quality of PSCFs in the National Health Service (NHS) for cholecystectomy, specifically comparing the listed complicat...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2018.0099
更新日期:2018-07-01 00:00:00
abstract:INTRODUCTION:Locked plates are commonly used to obtain fixation in periarticular and comminuted fractures. Their use has also gained popularity in repairing fractures in osteoporotic bone. These plates provide stable fixation and promote biological healing. Over the last 3 years, we have used over 150 locked plates wit...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588412X13373405386411
更新日期:2012-10-01 00:00:00
abstract::Thirty-seven patients who had had either a colonoscopy or a selective mesenteric angiogram while being investigated for severe or persistent gastrointestinal bleeding of obscure origin were reviewed. Failure to make a prompt diagnosis was partly responsible for the 16% hospital mortality in the series. Colonoscopy was...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract:INTRODUCTION:Adequate peri-operative analgesia following total knee arthroplasty (TKA) promotes earlier rehabilitation but remains problematic because of the drug side-effects. Peri-articular multimodal drug infiltration (PMDI) has been developed as an alternative strategy to avoid such complications. Autologous retran...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588410X12628812459733
更新日期:2010-05-01 00:00:00