Abstract：
BACKGROUND:About 60,000 patients are treated for hip fractures each year in the UK and the incidence is increasing. The majority of these patients are elderly and sick, and delay to operation may be fatal. The National Confidential Enquiry into Peri-Operative Deaths (NCEPOD) guidelines aim to improve quality of care for such patients. However, we present an audit highlighting the importance of balancing the implementation of such guidelines with available local resources to ensure that established priorities in the care of these patients remain paramount. METHODS:The 2001 NCEPOD report recommends that pre-operative transthoracic echocardiography be performed in patients who have evidence of aortic stenosis in order to identify those requiring invasive monitoring and high dependency unit care postoperatively. RESULTS:We have assessed the impact of the implementation of these guidelines on surgery for fractured neck of femur at our hospital, auditing both delay to surgery and the effect of the investigation on subsequent management. In the period studied prior to the introduction of the NCEPOD guidelines, no patients underwent pre-operative echocardiography. Subsequent to their introduction, 10% of patients underwent the investigation, which in the current study did not alter management but did delay surgery by 4-8 days in all cases. CONCLUSIONS:For such guidelines to be implemented, adequate resources should first be provided. In the absence of these resources, clinicians must balance the need for adequate pre-operative assessment with the need for urgent surgery.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Guryel E,Redfern DJ,Ricketts DMdoi
10.1308/003588404323043283subject
Has Abstractpub_date
2004-05-01 00:00:00pages
171-3issue
3eissn
0035-8843issn
1478-7083journal_volume
86pub_type
杂志文章abstract：:We present a rare case of a big oesophageal liposarcoma causing dysphagia and weight loss in a 75-year-old patient. Endoscopically, a pedunculated lesion with subtotal obstruction of the oesophageal lumen had been detected and thoracoabdominal oesophageal resection with gastric sleeve reconstruction was performed. Sur...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2017.0117
更新日期：2017-09-01 00:00:00
abstract：:The significance of congenital abnormalities in predisposing to portal hypertension and variceal haemorrhage needs to be remembered when these effects manifest in childhood, as portal venography will permit elucidation of the complicated congenital developmental abnormalities underlying the pathological condition and ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,评审
doi：
更新日期：1974-12-01 00:00:00
abstract：:A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necroti...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2016.0159
更新日期：2016-09-01 00:00:00
abstract：:Trauma care has evolved rapidly over the past decade. The benefits of operative fracture management in major trauma patients are well recognised. Concerns over early total care arose when applied broadly. The burden of additional surgical trauma could constitute a second hit, fuelling the inflammatory response and pre...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,评审
doi：10.1308/rcsann.2016.0111
更新日期：2016-05-01 00:00:00
abstract：:Intact parathyroid hormone (PTHi) has a relatively short half-life and levels fall significantly within 15 min of the successful excision of all the abnormal parathyroid glands during surgery for hyperparathyroidism. Monitoring this fall has been suggested as useful in decreasing the failure rate of neck explorations ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1993-01-01 00:00:00
abstract：INTRODUCTION:A study was completed to determine if operating has an effect on a surgeon's muscular fatigue. SUBJECTS AND METHODS:Six head and neck surgery consultants, two ENT registrars, 20 normal controls from two tertiary referral centres in the West Midlands participated in the study. Electromyography (EMG) measur...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588408X321710
更新日期：2008-11-01 00:00:00
abstract：:Inguinal hernia often presents as an emergency with obstruction and subsequent strangulation. We report a unique case where an inguinoscrotal sliding type hernia contained the entire hepatic flexure as its lead point, resulting in acute colonic obstruction and caecal wall perforation. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588413X13629960047551
更新日期：2013-09-01 00:00:00
abstract：:Introduction The weekend effect is a perceived difference in outcome between medical care provided at the weekend when compared to that of a weekday. Clearly multifactorial, this effect remains incompletely understood and variable in different clinical contexts. In this study we analyse factors relevant to the weekend...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2017.0116
更新日期：2018-01-01 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：:It is timely to review the place of surgery in the treatment of thyroid disease when for some years endocrinologists, pharmacologists, and radiotherapists have made most of the running. This account falls naturally into three parts, simple, malignant, and toxic goitre. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1979-03-01 00:00:00
abstract：:Internal herniation of the small bowel through a defect in the falciform ligament and subsequent small bowel obstruction is exceedingly rare with the majority of previous cases being attributed to congenital abnormalities. As laparoscopic techniques approach the forefront of modern surgery, an iatrogenic source for a ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2015.0022
更新日期：2015-09-01 00:00:00
abstract：:We describe a case of salmonella septic arthritis of the knee in a middle-aged woman with the following predisposing conditions: long-term corticosteroids and microscopic collagenous colitis. The patient presented with enteritis caused by the same strain 3 months before the arthritis. The first series of cultures were...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/147870804588
更新日期：2004-07-01 00:00:00
abstract：:A 1-year prospective study of all surgical activity was undertaken by the Orthopaedic Unit using two weighting systems for operative complexity: the Intermediate Equivalent (IE) and the Operative Complexity Score (OCS). The objectives were to define the difference between caseload and workload, and to formulate a reas...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1993-09-01 00:00:00
abstract：:Over 90% of patients referred to surgeons for investigation of rectal bleeding have haemorrhoids, fissure-in-ano or proctitis. Full investigation of these patients to exclude colonic neoplasia or inflammatory bowel disease imposes a considerable load on a hospital's resources as well as exposing the patient to signifi...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1998-03-01 00:00:00
abstract：:The authors present a case of pyomyositis of the piriformis muscle. This case, the first in the English speaking literature of piriformis involvement in a juvenile, serves to illustrate the need for a high index of suspicion when treating children with symptoms related to impalpable pathology deep in the pelvis and th...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,评审
doi：10.1308/147870804894
更新日期：2005-01-01 00:00:00
abstract：:INTRODUCTION In our regional spinal injuries unit, complex pressure ulcer reconstruction is facilitated by a monthly multidisciplinary team clinic. This study reviews a series of the more complex of these patients who underwent surgery as a joint case between plastics and other surgical specialties, aiming to provide ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,评审
doi：10.1308/rcsann.2016.0227
更新日期：2017-02-01 00:00:00
abstract：:Cystic nephroma is a rare lesion, but there has been an increased number of cases reported in the recent literature. Most cases have been discovered incidentally either on routine examination or during radiological investigations. There are two peaks of incidence, one in childhood and one in middle age and the conditi...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1989-11-01 00:00:00
abstract：:The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined p...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1985-11-01 00:00:00
abstract：:A high incidence of complications related to bleeding was observed after open prosthetic inguinal hernia repair. The site of injection of low-dose heparin into the abdominal wall was thought to be a possible causal factor for these complications. The wound complication rate after repair of primary unilateral inguinal ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 临床试验,杂志文章,多中心研究
doi：
更新日期：1998-01-01 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：:Analysis of the primary fellowship results showed that on average candidates were scoring a significantly higher mark in the MCQ than in the essay or viva. The level of MCQ marking has therefore been reset to the standards of the other parts of the examination. The need for continually monitoring the results of all ex...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1984-11-01 00:00:00
abstract：:A new jig is described which enables the technique for abdominal aortic aneurysm to be taught and practiced as it is performed by arterial surgeons at the present time. The aneurysm jig enables a plastic simulated aortic aneurysm to be opened as at operation to allow the inlaying of a Dacron tube sutured into place wi...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1987-09-01 00:00:00
abstract：INTRODUCTION:The Intercollegiate Membership of the Royal College of Surgeons (MRCS) is a mandatory examination to enter higher surgical specialty training in the UK. It is designed to help to ensure that successful candidates are competent to practice as higher surgical trainees. The annual review of competence progres...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2018.0153
更新日期：2018-10-05 00:00:00
abstract：:This review aims to change clinical practice and alert clinicians to consider that unrecognised coeliac disease may present acutely with abdominal pain. Targeting patients who have non-specific abdominal pain or coeliac-associated symptoms/diseases may improve diagnosis. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章,评审
doi：10.1308/003588406X85751
更新日期：2006-03-01 00:00:00
abstract：:Fibroepithelial polyps of the ureter are rare non-epithelial benign tumours with a slight female predominance. They are primarily located in the upper left ureter, incidentally diagnosed in patients who are evaluated for gross haematuria or renal colic. Fibroepithelial polyps are traditionally managed by open surgery ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2018.0198
更新日期：2019-02-01 00:00:00
abstract：:Luc's abscess is a rare but important complication of acute otitis media (AOM), whereby infection spreads from the middle ear, resulting in a subperiosteal collection beneath the temporal muscle. Unlike other extracranial abscesses relating to AOM, Luc's abscess is not believed to involve the mastoid bone. We present ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588414X13946184901281
更新日期：2014-07-01 00:00:00
abstract：INTRODUCTION:There has been regular dialogue regarding the importance of developing clinical networks to compensate for the steady decline in general paediatric surgery performed by adult surgeons. Despite this dialogue, there are no contemporary published data to quantify the issue. This report documents patterns in d...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2019.0178
更新日期：2020-04-01 00:00:00
abstract：:This report describes the mortality in 100 liver resections performed in 96 patients for seven benign and 93 malignant liver tumours. Repeat hepatectomy was performed in four patients who developed recurrences after the first liver resection. Two patients died within 30 days. The first was a 67-year-old man who died o...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1995-03-01 00:00:00
abstract：:The surgical commitment of No. 2 Field Hospital, R.A.M.C., during its stay in Jordan is presented. The majority of patients that were admitted had sustained war wounds, many of which were infected due to the delay in treatment. The difficulties encountered in their subsequent management are discussed. Special referenc...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1971-11-01 00:00:00
abstract：INTRODUCTION:The correction of anaemia prior to total hip arthroplasty reduces surgical risk, hospital stay and cost. This study considers the benefits of implementing a protocol of identifying and treating pre-operative anaemia whilst the patient is on the waiting list for surgery. PATIENTS AND METHODS:From a prospec...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588408X301163
更新日期：2008-09-01 00:00:00
