Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

英文中文

Striking a balance: Work-life balance an ethical dilemma 取得平衡：工作与生活的平衡是一个道德难题。

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-02-08 DOI: 10.1016/j.surge.2024.01.003

Suresh Annamalai

引用次数: 0

Demographics of deceased donor renal transplants in Ireland: A 10 year review showing the worrying increase of suicide as a source for organ donation 爱尔兰已故捐赠者肾移植的人口统计：10 年回顾：自杀作为器官捐献来源的增加令人担忧。

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-02-07 DOI: 10.1016/j.surge.2023.12.004

A. Naughton , K. Ringrose , I. Robertson , D. Little , N.F. Davis

Introduction

Kidney transplantation is the treatment of choice for patients with end stage renal disease. The primary aim of this study was to assess the demographics of deceased kidney donors over the last ten years and to assess for gender variations in deceased donor demographics over an extended period.

Methods

A retrospective data analysis was carried out using data from the national renal transplant database. All deceased donors who donated a kidney between 1st January 2012 and 31st December 2021 were included. Data points extracted included gender, age, cause of death and month of death. Descriptive analyses were carried out using Excel v16.67.

Results

A total of 1219 kidneys from 650 donors were donated over the ten-year period. The mean donor age was 44.01 years (range 1–74 years). The most common cause of death overall was subarachnoid haemorrhage (SAH), which was the cause of death in 27.8 % of donors (n = 180). Male donors accounted for 57.8 % of donors overall (n = 376). Variation in causes of death was observed between male and female donors, and between younger and older donors. 9 % of male deaths were from suicide compared with 5 % of female deaths. 6 % of male deaths were due to a traumatic head injury, with this accounting for 2 % of female deaths. Deaths due to assault made up 2 % of male donor deaths, but were not a cause of death for any female donors.

Conclusion

SAH and intracranial bleeds were the most common cause of death in both groups for deceased donor renal transplantation. Incidence of suicide as cause of death in deceased donors is rising in males.

简介肾移植是终末期肾病患者的首选治疗方法。本研究的主要目的是评估过去十年中已故肾脏捐献者的人口统计学特征，并评估已故捐献者人口统计学特征在较长时期内的性别差异：利用国家肾移植数据库的数据进行了回顾性数据分析。所有在 2012 年 1 月 1 日至 2021 年 12 月 31 日期间捐献肾脏的已故捐献者均包括在内。提取的数据点包括性别、年龄、死亡原因和死亡月份。使用 Excel v16.67 进行描述性分析：十年间，共有 650 名捐献者捐献了 1219 个肾脏。捐献者的平均年龄为 44.01 岁（1-74 岁不等）。最常见的死因是蛛网膜下腔出血（SAH），27.8%的捐献者（n = 180）死于此病。男性捐献者占捐献者总数的 57.8%（n = 376）。男性捐献者和女性捐献者之间、年轻捐献者和年长捐献者之间的死因存在差异。男性捐献者中有 9% 死于自杀，而女性捐献者中只有 5%。6%的男性死亡原因是头部外伤，而女性死亡原因是头部外伤，占 2%。男性捐献者的死亡原因中有2%是死于攻击，但女性捐献者的死亡原因中没有这一项：结论：SAH和颅内出血是两组已故肾移植供体中最常见的死因。自杀作为已故捐献者死因的发生率在男性中呈上升趋势。

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引用次数: 0

AI generated literature reviews in musculoskeletal radiology: Comment 人工智能生成的肌肉骨骼放射学文献综述：评论

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-02-02 DOI: 10.1016/j.surge.2024.01.002

Hinpetch Daungsupawong, Viroj Wiwanitkit

引用次数: 0

List of editors 编辑名单

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-01-18 DOI: 10.1016/S1479-666X(24)00003-9

引用次数: 0

An evaluation of AI generated literature reviews in musculoskeletal radiology 评估人工智能生成的肌肉骨骼放射学文献综述。

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-01-12 DOI: 10.1016/j.surge.2023.12.005

N. Jenko , S. Ariyaratne , L. Jeys , S. Evans , K.P. Iyengar , R. Botchu

Purpose

The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be avoided by using programmes trained for a more specific scope. In this study we compared the performance of a new AI tool (the-literature.com) to the latest version OpenAI's ChatGPT (GPT-4) in summarizing topics that the authors have significantly contributed to.

Methods

The AI tools were asked to produce a literature review on 7 topics. These were selected based on the research topics that the authors were intimately familiar with and have contributed to through their own publications. The output produced by the AI tools were graded on a 1–5 Likert scale for accuracy, comprehensiveness, and relevance by two fellowship trained consultant radiologists.

Results

The-literature.com produced 3 excellent summaries, 3 very poor summaries not relevant to the prompt, and one summary, which was relevant but did not include all relevant papers. All of the summaries produced by GPT-4 were relevant, but fewer relevant papers were identified. The average Likert rating was for the-literature was 2.88 and 3.86 for GPT-4. There was good agreement between the ratings of both radiologists (ICC = 0.883).

Conclusion

Summaries produced by AI in its current state require careful human validation. GPT-4 on average provides higher quality summaries. Neither tool can reliably identify all relevant publications.

目的：使用人工智能（AI）工具帮助总结医学和研究方面的信息最近引起了人们的极大兴趣。虽然 ChatGPT 等工具能产生令人信服且听起来自然的输出结果，但有时答案并不正确。我们希望通过使用针对更具体范围进行训练的程序来避免其中的一些缺点。在这项研究中，我们比较了一款新的人工智能工具（the-literature.com）与最新版 OpenAI 的 ChatGPT（GPT-4）在总结作者有重大贡献的主题方面的表现：方法：要求人工智能工具对 7 个主题进行文献综述。方法：要求人工智能工具对 7 个主题进行文献综述，这些主题是根据作者通过自己的出版物所熟悉和参与的研究主题选定的。人工智能工具生成的结果由两名受过研究培训的放射科顾问医生根据准确性、全面性和相关性按 1-5 级李克特量表进行评分：结果：The-literature.com 制作了 3 份出色的摘要，3 份非常差的摘要与提示无关，还有一份摘要与提示有关，但没有包括所有相关论文。GPT-4 提出的所有摘要都是相关的，但发现的相关论文较少。文献》的平均李克特评分为 2.88，《GPT-4》的平均李克特评分为 3.86。两位放射科医生的评分结果非常一致（ICC = 0.883）：结论：目前人工智能生成的摘要需要经过仔细的人工验证。GPT-4提供的摘要平均质量更高。两种工具都不能可靠地识别所有相关出版物。

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引用次数: 0

Posterior cruciate-retaining versus posterior stabilising prostheses for primary total knee arthroplasty in treating osteoarthritis: A systematic review and meta-analysis of randomised controlled trials 治疗骨关节炎的初级全膝关节置换术后十字韧带固定假体与后稳定假体：随机对照试验的系统回顾和荟萃分析。

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-01-03 DOI: 10.1016/j.surge.2023.12.002

Siraj Benbarka , Saja Benbarka

Background

Total knee replacements (TKRs) are successful operations that utilities several operative techniques including cruciate retaining (CR) and posterior stabilising (PS) prostheses. To date, neither approach has proved superior. Techniques and implants are under constant evolution and new trials are published. The purpose of this meta-analysis is to determine the current risks and benefits of these two approaches so that an up-to-date clinical recommendation can be given as to which approach if any is superior.

Methods

We searched PubMed, Cochrane, Embase, Scopus, EBCSO, and Google Scholar. Risk of bias was assessed based on the Cochrane risk of bias criteria. Meta-analysisusing the random effects model was performed by the STATA software and results were displayed on forest plots. Sensitivity analysis was performed for possible causes of heterogeneity.

Results

From 1164 studies, 15 eligible trials were included. Meta-analysis showed that the CR approach had significantly lower Range of Motion and HSS scores. There was no significant difference in KSS, OKS, VAS, or WOMAC scores. Blood loss was significantly less in the CR group. However, there was no significant difference in total complications or revisions. Sensitivity analysis did not reveal any differences in the results.

Conclusion

Despite inherent limitations, this updated meta-analysis suggests that both CR and PS approaches continue to be equivocal in terms of clinical outcomes. Both patients and surgeons can be confident in selecting either approach.

Level of evidence

Level I.

Systematic review registration

the protocol of this systematic review has been registered on PROSPERO. Registration number: CRD42023391435.

背景：全膝关节置换术（TKRs）是一项成功的手术，采用了多种手术技术，包括十字韧带固定假体（CR）和后路稳定假体（PS）。迄今为止，这两种方法均未被证明具有优越性。技术和植入物在不断发展，新的试验也在不断发表。本荟萃分析的目的是确定这两种方法目前的风险和益处，以便就哪种方法更优越给出最新的临床建议：我们检索了 PubMed、Cochrane、Embase、Scopus、EBCSO 和 Google Scholar。根据 Cochrane 的偏倚风险标准对偏倚风险进行了评估。使用 STATA 软件以随机效应模型进行 Meta 分析，结果显示在森林图上。对可能导致异质性的原因进行了敏感性分析：从 1164 项研究中，共纳入了 15 项符合条件的试验。Meta 分析表明，CR 方法的活动范围和 HSS 评分明显较低。KSS、OKS、VAS或WOMAC评分无明显差异。CR 组的失血量明显较少。不过，总并发症和翻修率没有明显差异。敏感性分析未发现结果有任何差异：尽管存在固有的局限性，但这项最新的荟萃分析表明，CR和PS方法在临床效果方面仍然存在差异。患者和外科医生可以放心选择这两种方法：系统综述注册：本系统综述的方案已在 PROSPERO 上注册：CRD42023391435。

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引用次数: 0

A 10-year experience with anastomotic leaks in upper gastrointestinal surgery–Retrospective cohort study 上消化道手术吻合口漏的 10 年经验--回顾性队列研究

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-01-02 DOI: 10.1016/j.surge.2023.11.001

Jia-Hao Law, Charmaine Zhi-Mei Ng, Sarah-Kei Lauw, Jimmy Bok Yan So, Guowei Kim, Asim Shabbir

Background

Anastomotic leak (AL) in upper gastrointestinal (UGI) surgery continues to be a diagnostic challenge. We seek to identify clinical parameters that predict AL and examine the effectiveness of investigations in evaluating AL following UGI surgeries.

Methods

592 patients underwent UGI surgeries with an anastomosis between January 2011 and January 2021. Data on patient characteristics, surgery, postoperative investigations and outcomes were prospectively collected and analysed.

Results

The overall occurrence of AL was 6.4 %. Tachycardia >120 BPM (OR 6.959, 95 % CI 1.856–26.100, p = 0.004) and leukocyte count >19 × 10⁹/L (OR 3.327, 95 % CI 1.009–10.967, p = 0.048) were independent predictors of AL. On multivariate analysis, patients whose anastomosis was deemed high risk and had pre-emptive investigation done postoperatively to exclude a leak were less likely to require intervention and were more likely to be managed conservatively (66.7 % vs 14.3 %, p = 0.025). Methylene blue test, oral contrast study and Computed Tomography scan with intravenous and oral contrast had 50.0 %, 20.0 % and 9.1 % false negative results, while esophagogastroduodenoscopy had none. There was no misdiagnosed AL when more than 1 investigation (n = 15, 39.5 %) were performed.

Conclusion

Our study demonstrates that the presence of a triad including desaturation, tachycardia and leucocytosis predicts for AL following UGI surgery and for confirmation of a leak, evaluation with 2 or more investigation is needed. A practice of evaluating high risk anastomosis prior to commencement of feeding decreased the need for surgical intervention and improves success of conservative treatment.

背景上消化道（UGI）手术中的吻合口漏（AL）仍然是一项诊断难题。我们试图找出能预测 AL 的临床参数，并研究评估上消化道手术后 AL 的检查效果。方法 2011 年 1 月至 2021 年 1 月间，592 名患者接受了上消化道手术吻合。对患者特征、手术、术后检查和结果等数据进行了前瞻性收集和分析。心动过速>120 BPM（OR 6.959，95 % CI 1.856-26.100，p = 0.004）和白细胞计数>19 × 109/L（OR 3.327，95 % CI 1.009-10.967，p = 0.048）是AL的独立预测因素。在多变量分析中，吻合口被视为高风险并在术后进行了预防性检查以排除渗漏的患者需要干预的可能性较低，更有可能采取保守治疗（66.7% vs 14.3%，p = 0.025）。亚甲蓝试验、口服造影剂研究以及静脉和口服造影剂的计算机断层扫描的假阴性结果分别为 50.0%、20.0% 和 9.1%，而食管胃十二指肠镜检查没有假阴性结果。结论：我们的研究表明，出现饱和度降低、心动过速和白细胞增多等三联征可预测 UGI 手术后出现 AL，要确认泄漏，需要进行 2 次或更多检查。在开始喂食前评估高风险吻合口的做法减少了手术干预的需要，提高了保守治疗的成功率。

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引用次数: 0

Perceptions of online surgical-focused learning amongst surgeons during the COVID pandemic: A scoping review 2020–22 COVID 大流行期间外科医生对在线外科学习的看法：范围审查 2020-22

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2023-12-23 DOI: 10.1016/j.surge.2023.11.006

S.M. McHugh , E. Kheirelseid , S. Hyde , P.F. Conway

Introduction

During the COVID pandemic many centres adopted e-learning as a tool to adhere to social distancing recommendations while continuing to provide ongoing postgraduate medical education. We aimed to complete this scoping review in order to map experience and perceptions amongst surgeons and surgical trainees to remote learning during the COVID pandemic.

Methods

Using Arksey and O'Malley's five step model for conducting a scoping review, a systematic search strategy was undertaken across three online databases SCOPUS, MEDLINE and Web of Science. Only original articles in English in the field of postgraduate education in surgery were included.

Results

44 studies were selected for review. Of these 44, 21 were studies of perception of a newly developed e-learning tool/platform. 17 were surveys of surgeon's attitudes towards e-learning during the COVID pandemic. The remaining 6 studies were studies of knowledge or skills acquired through new e-learning, which included a survey of experience. The United States was the most common country of origin with General Surgery the most represented surgical speciality. Response rates across all three study subgroups were on average >60%. Surgeon's experience of e-learning was reported in only positive terms in 86% (n = 38/44) of studies.

Conclusions

This paper is informative in that it focuses specifically on surgeons' perceptions of a e-learning tools used in addition to skills or knowledge gained. Positive e-learning experience reported in these studies may lead to more blended learning curriculums being developed, deployed and evaluated going forward.

导言在 COVID 大流行期间，许多中心采用了电子学习作为一种工具，在继续提供研究生医学教育的同时遵守社会疏远建议。我们的目标是完成这项范围界定综述，以了解外科医生和外科学员在 COVID 大流行期间对远程学习的经验和看法。方法采用 Arksey 和 O'Malley 的范围界定综述五步模型，在 SCOPUS、MEDLINE 和 Web of Science 三个在线数据库中采用系统检索策略。结果共选取了 44 项研究进行综述。在这 44 项研究中，有 21 项是关于对新开发的电子学习工具/平台的看法的研究。17 项研究调查了外科医生在 COVID 流行期间对电子学习的态度。其余 6 项研究是对通过新的电子学习获得的知识或技能的研究，其中包括一项经验调查。美国是最常见的原籍国，普通外科是最具代表性的外科专业。所有三个研究分组的回复率平均为 60%。86%（n = 38/44）的研究报告中，外科医生对电子学习的体验都是正面的。结论这篇论文的信息量很大，因为它特别关注外科医生对所使用的电子学习工具以及所获得的技能或知识的看法。这些研究中报告的积极的电子学习经验可能会促使今后开发、部署和评估更多的混合学习课程。

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引用次数: 0

A rare presentation of mesenteric cyst as persistent ascites: A case report 肠系膜囊肿罕见地表现为顽固性腹水：病例报告

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2023-12-22 DOI: 10.1016/j.surge.2023.11.013

Muhammad Danial Khan , Iqra Nawaz , Arooba Niazi , Adil Mahmood

Background

Mesenteric cysts have been typically described as cystic lesions of mesentery or omentum occurring either intra-abdominally or in the retroperitoneum. With no typical symptoms, the preoperative diagnosis of mesenteric cyst becomes challenging to establish.

Patient and methods

In this case report, we describe the case of a 29-year-old female who presented with abdominal distension for seven years associated with intermittent constipation. Following complete history, a meticulous physical examination was performed. Laboratory investigations and radiological imaging techniques were used to facilitate the diagnosis which was confirmed on laparotomy.

Results

Physical examination revealed abdominal ascites. Laboratory investigations were unremarkable. Abdominal ultrasound revealed multiloculated massive ascites. A well-defined cystic area 27 × 18cm displacing abdominal viscera was observed on computed tomography (abdomen and pelvis) with contrast medium. Exploratory laparotomy revealed a massive cyst involving almost the entire peritoneal cavity. On histopathology, no signs of malignancy were reported. The post-operative course was excellent, and the patient was discharged following surgery.

Conclusion

As this lesion is rarely considered preoperatively, and the clinical manifestations can be non-specific, we report this case of mesenteric cyst mimicking ascites in order to inform improved decision making among healthcare professionals regarding the timely diagnosis and appropriate management.

背景肠系膜囊肿通常被描述为发生在腹腔内或腹膜后的肠系膜或网膜的囊性病变。由于肠系膜囊肿没有典型的症状，因此术前诊断肠系膜囊肿变得非常困难。在本病例报告中，我们描述了一名 29 岁女性的病例，她出现腹胀 7 年，伴有间歇性便秘。在详细询问病史后，对患者进行了细致的体格检查。结果体格检查发现腹水。实验室检查无异常。腹部超声波检查发现了多灶性巨大腹水。使用造影剂进行计算机断层扫描（腹部和盆腔）时，观察到一个轮廓清晰的囊性区域，大小为 27 × 18 厘米，使腹腔内脏移位。剖腹探查术发现，巨大的囊肿几乎涉及整个腹腔。组织病理学检查未发现恶性肿瘤迹象。由于这种病变很少在术前被考虑，而且临床表现可能没有特异性，因此我们报告了这例模仿腹水的肠系膜囊肿病例，以帮助医护人员更好地做出及时诊断和适当处理的决策。

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引用次数: 0

Time to retire the term “high volume” and replace with “high quality” for HPB centers: A position statement from Caribbean chapter of AHPBA 是时候让 "高容量 "一词退出历史舞台，代之以 "高质量 "来形容 HPB 中心了：美国高血压协会加勒比海分会的立场声明。

IF 2.5 4区医学 Q2 Medicine

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2023-12-22 DOI: 10.1016/j.surge.2023.11.012

Shamir O. Cawich, Parul J. Shukla, Shailesh V. Shrikhande, Elijah Dixon, Neil W. Pearce, Rahul Deshpande, Wesley Francis

引用次数: 0

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