Health and social care currently account for between 4-5% of UK annual emissions1. Recognising this, the NHS has set a net zero goal for direct emissions by 2040, alongside an 80% reduction goal before 20322. Net zero here refers to a balance between residual emissions and carbon offsets. To this end, trusts are exploring measures to reduce their direct emissions through changes in practice, renewable electricity generation, and energy efficiency improvements. The NHS will then offset any remaining emissions after 2040. Surgery and anaesthesia together account for 8% of the carbon footprint associated with acute trusts at present, with nearly half of this due to the use of anaesthetic vapours and gases, predominantly nitrous oxide and desflurane3. The NHS net zero panel expect 2% of its total emissions reduction will be achieved through changes to the delivery of anaesthesia4. This raises the question: what changes can be made to anaesthetic practise to achieve this goal?
{"title":"An evidence-based approach towards sustainable anaesthesia","authors":"Jane Barnard, S. Kudsk-Iversen","doi":"10.37707/jnds.v3i1.250","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.250","url":null,"abstract":"Health and social care currently account for between 4-5% of UK annual emissions1. Recognising this, the NHS has set a net zero goal for direct emissions by 2040, alongside an 80% reduction goal before 20322. Net zero here refers to a balance between residual emissions and carbon offsets. To this end, trusts are exploring measures to reduce their direct emissions through changes in practice, renewable electricity generation, and energy efficiency improvements. The NHS will then offset any remaining emissions after 2040. Surgery and anaesthesia together account for 8% of the carbon footprint associated with acute trusts at present, with nearly half of this due to the use of anaesthetic vapours and gases, predominantly nitrous oxide and desflurane3. The NHS net zero panel expect 2% of its total emissions reduction will be achieved through changes to the delivery of anaesthesia4. This raises the question: what changes can be made to anaesthetic practise to achieve this goal?","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128720148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Appropriate concordance between surgeon, patient and allied healthcare professionals is essential in preventing errors such as ureteric stents being left in situ. This case highlights the classic “Swiss cheese” model of errors leading to the described consequences. The case discusses pertinent points regarding appropriate pre-stent counselling of patients (although this may not always be feasible in the emergency setting), the emphasis on the surgeon who places a stent being responsible for arrange an appropriate management plan for the stent, the notification from the administrative team if a patient fails to attend follow up, as well as the joint responsibility between patient and surgeon to ensure the management plan is followed. Unfortunately, there is no widely used nationalised system in place for the recording and subsequent follow up of stent insertions. This usually either relies on the surgeon themselves to book / arrange follow up for the stent (sometimes with the help of the administrative team), and/or a stent registry such as the one described on the British Association of Urological Surgeons (BAUS) website. However, these locally arranged systems again may be prone to errors such as forgetting or incorrectly recording the stent insertion, emails to administrative teams being lost or not interpreted correctly, database corruption/errors/unavailability, or patients moving out of area. Special care should be taken with patients who may be at a higher risk of having a forgotten stent. Specifically, those who may have no sensation of a stent, and those who may not fully understand the potential complications of not being followed up appropriately such as in this case. This report presents the case of Mr X, a 70-year-old man who presented with acute-on-chronic renal failure due to an extensively encrusted ureteral stent that had been placed to alleviate obstructive uropathy, and subsequently forgotten for almost two years.
{"title":"One That Got Away: A Case of The Forgotten Ureteral Stent","authors":"C. Otasowie, K. Chan","doi":"10.37707/jnds.v3i1.162","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.162","url":null,"abstract":"\u0000\u0000\u0000Appropriate concordance between surgeon, patient and allied healthcare professionals is essential in preventing errors such as ureteric stents being left in situ. This case highlights the classic “Swiss cheese” model of errors leading to the described consequences. The case discusses pertinent points regarding appropriate pre-stent counselling of patients (although this may not always be feasible in the emergency setting), the emphasis on the surgeon who places a stent being responsible for arrange an appropriate management plan for the stent, the notification from the administrative team if a patient fails to attend follow up, as well as the joint responsibility between patient and surgeon to ensure the management plan is followed. Unfortunately, there is no widely used nationalised system in place for the recording and subsequent follow up of stent insertions. This usually either relies on the surgeon themselves to book / arrange follow up for the stent (sometimes with the help of the administrative team), and/or a stent registry such as the one described on the British Association of Urological Surgeons (BAUS) website. However, these locally arranged systems again may be prone to errors such as forgetting or incorrectly recording the stent insertion, emails to administrative teams being lost or not interpreted correctly, database corruption/errors/unavailability, or patients moving out of area.\u0000Special care should be taken with patients who may be at a higher risk of having a forgotten stent. Specifically, those who may have no sensation of a stent, and those who may not fully understand the potential complications of not being followed up appropriately such as in this case. This report presents the case of Mr X, a 70-year-old man who presented with acute-on-chronic renal failure due to an extensively encrusted ureteral stent that had been placed to alleviate obstructive uropathy, and subsequently forgotten for almost two years.\u0000\u0000\u0000","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"201 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115703604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial for JNDS","authors":"A. Handa","doi":"10.37707/jnds.v3i1.242","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.242","url":null,"abstract":"<jats:p>n/a</jats:p>","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115671161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ms Ann Etohan Ogbemudia","authors":"Susannah M Black, Magdalena Chmura","doi":"10.37707/jnds.v3i1.223","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.223","url":null,"abstract":"","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124694491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sustainability in Surgery; a Series","authors":"S. Black","doi":"10.37707/jnds.v3i1.224","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.224","url":null,"abstract":"<jats:p>n/a</jats:p>","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"434 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132416053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Picture a Scientist","authors":"Emily Hotine","doi":"10.37707/jnds.v3i1.228","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.228","url":null,"abstract":"<jats:p>n/a</jats:p>","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123425298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kidney transplantation is considered the optimal therapy for end-stage renal disease (ESRD). It improves quality of life and survival and is less of a financial burden in comparison to dialysis. However, there is a national shortage of organ donors, which hinders the success of kidney transplantation and can result in long waiting times. The continued mismatch between donor supply and demand has led to the exploration of new avenues of organ acquisition. This report will describe the case of Mr A, who had a kidney transplant in 2020. This report will review the recent literature comparing the different types of deceased donor organs available for transplant, and discuss the strategies used to increase donor organ supply.
{"title":"The Use of Deceased Donor Organs in Kidney Transplantation","authors":"Triya Chakravorty","doi":"10.37707/jnds.v3i1.130","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.130","url":null,"abstract":"Kidney transplantation is considered the optimal therapy for end-stage renal disease (ESRD). It improves quality of life and survival and is less of a financial burden in comparison to dialysis. However, there is a national shortage of organ donors, which hinders the success of kidney transplantation and can result in long waiting times. The continued mismatch between donor supply and demand has led to the exploration of new avenues of organ acquisition. This report will describe the case of Mr A, who had a kidney transplant in 2020. This report will review the recent literature comparing the different types of deceased donor organs available for transplant, and discuss the strategies used to increase donor organ supply.","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131190070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. This report presents a case of conservative management of appendicitis during pregnancy. The aim is to discuss the role of conservative treatment for a condition that is routinely treated surgically. This is important because research on the management of appendicitis during pregnancy is limited compared to the general population. Conservative management can be a safe option for uncomplicated appendicitis. However, the increased risk of appendix perforation in pregnancy and implications for foetal health commonly make surgery a more attractive option. This risk is a key driver for higher rates of negative appendectomies during pregnancy. The COVID-19 pandemic provides a unique opportunity to remedy the paucity of research of appendicitis during pregnancy. This is because conservative management was heavily utilised at the start of the pandemic. Therefore, following up pregnant patients in this cohort will provide a valuable insight into the risks and benefits of conservative versus surgical management.
{"title":"Conservative versus Surgical Management of Appendicitis During Pregnancy","authors":"Chantal Edwardes","doi":"10.37707/jnds.v3i1.157","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.157","url":null,"abstract":"Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. This report presents a case of conservative management of appendicitis during pregnancy. The aim is to discuss the role of conservative treatment for a condition that is routinely treated surgically. This is important because research on the management of appendicitis during pregnancy is limited compared to the general population. Conservative management can be a safe option for uncomplicated appendicitis. However, the increased risk of appendix perforation in pregnancy and implications for foetal health commonly make surgery a more attractive option. This risk is a key driver for higher rates of negative appendectomies during pregnancy. The COVID-19 pandemic provides a unique opportunity to remedy the paucity of research of appendicitis during pregnancy. This is because conservative management was heavily utilised at the start of the pandemic. Therefore, following up pregnant patients in this cohort will provide a valuable insight into the risks and benefits of conservative versus surgical management. ","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129867898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute appendicitis is a common surgical presentation usually managed with laparoscopic appendicectomy. There has been long-standing debate as to whether conservative management of acute appendicitis could provide a superior alternative to surgical management. COVID-19 infection emerged in December 2019 and was labelled as a pandemic by the World Health Organisation in March 2020. Re-structuring as a result of the pandemic forced rapid changes in guidelines from recommending surgical management to advocating for medical management in all cases of uncomplicated acute appendicitis. Mr C had a delayed presentation of complicated acute appendicitis as a result of anxiety about being in a clinical environment during the pandemic. This was successfully managed with surgery and a 4-day inpatient stay. This case report evaluates the best approach for the treatment of acute appendicitis, evaluates whether a change in management was appropriate in the case of a pandemic and details how to avoid more cases of delayed and complex presentation as a result of COVID-19.
{"title":"Management of acute appendicitis in the COVID era: A Case Study","authors":"Francesca Back","doi":"10.37707/jnds.v3i1.134","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.134","url":null,"abstract":"Acute appendicitis is a common surgical presentation usually managed with laparoscopic appendicectomy. There has been long-standing debate as to whether conservative management of acute appendicitis could provide a superior alternative to surgical management. COVID-19 infection emerged in December 2019 and was labelled as a pandemic by the World Health Organisation in March 2020. Re-structuring as a result of the pandemic forced rapid changes in guidelines from recommending surgical management to advocating for medical management in all cases of uncomplicated acute appendicitis. Mr C had a delayed presentation of complicated acute appendicitis as a result of anxiety about being in a clinical environment during the pandemic. This was successfully managed with surgery and a 4-day inpatient stay. This case report evaluates the best approach for the treatment of acute appendicitis, evaluates whether a change in management was appropriate in the case of a pandemic and details how to avoid more cases of delayed and complex presentation as a result of COVID-19.","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130319982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laparoscopic cholecystectomies (LCs) are the current gold standard treatment for gallstone disease. However, iatrogenic bile duct injury (IBDI) is a well-documented complication that significantly raises morbidity, mortality, length of hospitalisation, and financial costs. With the popularisation of LCs in the 1990s the incidence of IBDIs went up from 0.1-0.5% in open procedures to 3% in LCs. With an increasing amount of surgical experience, academic literature, and widespread recognition of the issue, the prevalence of IBDIs in the modern era is falling but they still occur with serious consequences. This report presents a case of an elective LC with iatrogenic common bile duct (CBD) injury that was repaired with a Roux-en-Y hepaticojejunostomy that was later complicated by anastomotic leak and sepsis. It will go on to review the evidence addressing why this happens and how best to prevent it, before briefly touching on management and associated complications.
{"title":"Bile Duct Injury During Laparoscopic Cholecystectomy - a Preventable Issue?","authors":"Jennifer Knight","doi":"10.37707/jnds.v3i1.178","DOIUrl":"https://doi.org/10.37707/jnds.v3i1.178","url":null,"abstract":"Laparoscopic cholecystectomies (LCs) are the current gold standard treatment for gallstone disease. However, iatrogenic bile duct injury (IBDI) is a well-documented complication that significantly raises morbidity, mortality, length of hospitalisation, and financial costs. With the popularisation of LCs in the 1990s the incidence of IBDIs went up from 0.1-0.5% in open procedures to 3% in LCs. With an increasing amount of surgical experience, academic literature, and widespread recognition of the issue, the prevalence of IBDIs in the modern era is falling but they still occur with serious consequences. This report presents a case of an elective LC with iatrogenic common bile duct (CBD) injury that was repaired with a Roux-en-Y hepaticojejunostomy that was later complicated by anastomotic leak and sepsis. It will go on to review the evidence addressing why this happens and how best to prevent it, before briefly touching on management and associated complications.","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"367 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124601265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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