Durable Results of Mitomycin C Injection with Internal Urethrotomy for Refractory Bladder Neck Contractures: Multi-institutional Experience.

Introduction: We evaluated our intermediate term experience with radial urethrotomy and intralesional mitomycin C injection in patients with recurrent bladder neck contractures. Recurrent bladder neck contractures in which previous endoscopic treatment failed pose a difficult management dilemma.

Methods: Prospectively collected data were reviewed in a retrospective manner of patients presenting with recurrent bladder neck contractures from January 2007 to June 2014.

Improving postoperative handover: a prospective observational study.

Background: The information provided during the postoperative handover influences the delivery of care of patients in the postoperative recovery unit through their care on the ward. There is a need for a structured and systematic approach to postoperative handover. The aim of this study was to improve postoperative handover through the implementation of a new handover protocol, which involved a handover proforma and standardization of the handover process.

Day-case re-do varicose vein surgery.

Objective: To assess whether re-do varicose vein surgery as a day case is feasible and safe.

Methods: Data were collected retrospectively on 70 consecutive patients (77 legs) undergoing re-do sapheno-femoral or sapheno-popliteal ligation by consultant surgeons as day cases. Follow-up was by structured telephone interview.

Colorectal surgery and its impact on male sexual function.

The quality of functional outcome has become increasingly important in view of improvement in prognosis with colorectal cancer patients. Sexual dysfunction remains a common problem after colorectal cancer treatment, despite the good oncologic outcomes achieved by expert surgeons. Although radiotherapy and chemotherapy contribute, surgical nerve damage is the main cause of sexual dysfunction.

The effect of insurance status on outcomes after laparoscopic cholecystectomy.

Background: Part of the ongoing healthcare debate is the care of uninsured patients. A common theory is that without regular outpatient care, these patients present to the hospital in the late stages of disease and therefore have worse outcomes. The purpose of this study was to evaluate any differences in outcomes after laparoscopic cholecystectomies between insured and uninsured patients.

Factors having implications on re-retinal detachments after silicone oil removal.

Aim: To investigate factors having implications on re-retinal detachments (reRD) after silicone oil removal (SOR).

Materials And Methods: A retroprospective study of 412 eyes (with attached retina after vitrectomy with silicone oil for rhegmatogenous RD) which underwent SOR was conducted and were followed up for six months after SOR. They were studied for various factors like encirclage, 360° retinopexy, oil emulsification at the time of SOR, duration of oil tamponade and previous retinal surgeries prior to SOR with their implications on reRD after SOR.

The use of a surgery-specific written examination in the selection process of surgical residents.

Objective: Selection of surgical residents is a difficult task, and program directors are interested in identifying the best candidates. Among the qualities being sought after is the ability to acquire surgical knowledge, and eventually do well on their board examinations. During the interview process, many programs use results from the United States Medical Licensing Exam (USMLE) to identify residents they think will do well academically.

An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery.

Objective: To investigate the nature of process failures in postoperative care, to assess their frequency and preventability, and to explore their relationship to adverse events.

Background: Adverse events are common and are frequently caused by failures in the process of care. These processes are often evaluated independently using clinical audit.

Delaying an appendectomy: is it safe?

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes.

Failures in communication and information transfer across the surgical care pathway: interview study.

Background And Objectives: Effective communication is imperative to safe surgical practice. Previous studies have typically focused upon the operating theatre. This study aimed to explore the communication and information transfer failures across the entire surgical care pathway.

Pars Plana Vitrectomy With or Without Silicone Oil Endotamponade in Surgical Management of Endophthalmitis.

Purpose: To compare outcomes of pars plana vitrectomy (PPV) with and without silicone oil injection (SOI) in surgical management of endophthalmitis.

Design: This was a prospective, randomized, interventional, comparative study.

Methods: This is a prospective, randomized, interventional, comparative study comprising 129 eyes with endophthalmitis (postsurgical and traumatic) that underwent PPV.

The degree of gallbladder wall thickness and its impact on outcomes after laparoscopic cholecystectomy.

Background: Laparoscopic cholecystectomy is the gold-standard procedure for management of symptomatic gallstone disease. Increased rates of conversion to an open procedure, increased postoperative complications, and longer lengths of stay are seen in thick-walled gallbladders. Previous studies have only evaluated gallbladder walls as being thick or not thick, without looking at the degree of thickness.

Quantitative analysis of intraoperative communication in open and laparoscopic surgery.

Background: Communication is important for patient safety in the operating room (OR). Several studies have assessed OR communications qualitatively or have focused on communication in crisis situations. This study used prospective, quantitative observation based on well-established communication theory to assess similarities and differences in communication patterns between open and laparoscopic surgery.

The impact of body mass index on outcomes after laparoscopic cholecystectomy.

Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallstone disease. Some cases will be converted to open surgery and others will have complications, both leading to worse outcomes. The purpose of this study was to evaluate whether an increased body mass index (BMI) is associated with increased rates of conversion or complication.

Appendicitis, is it an emergency?

Prompt appendectomy has always been a standard of care because of the risk of progression in pathology. This time honored practice has been recently challenged by studies, suggesting that appendicitis can be operated on electively. The aim of this study is to examine whether delayed intervention in acute appendicitis is safe by correlating the interval from presentation to operation with the operative and postoperative complications.

Simultaneous presentation of branch retinal artery occlusion and vitreomacular traction.

Purpose: To report a case of simultaneous presentation of branch retinal artery occlusion and vitreomacular traction and the auxiliary role of optical coherence tomography and fluorescein angiogram in the management of this case.

Methods: A 42-year-old female patient presented with diminution of vision in the left eye. Visual acuity was 20/200.

Evaluation of postoperative handover using a tool to assess information transfer and teamwork.

Objective: To assess the feasibility, validity, and reliability of a postoperative Handover Assessment Tool (PoHAT) and to evaluate the current practices of the postoperative handover at 2 large European hospitals.

Background: Postoperative handover is one of the most critical phases in the care of a patient undergoing surgery. However, handovers are largely informal and variable.

Quality of care management decisions by multidisciplinary cancer teams: a systematic review.

Background: Factors that affect the quality of clinical decisions of multidisciplinary cancer teams (MDTs) are not well understood. We reviewed and synthesised the evidence on clinical, social and technological factors that affect the quality of MDT clinical decision-making.

Methods: Electronic databases were searched in May 2009.

Macular hole progression after intravitreal bevacizumab for hemicentral retinal vein occlusion.

Macular edema secondary to retinal vein occlusion is commonly being treated with off-label intravitreal bevacizumab with good outcomes. A significant reduction in macular edema and improvement in visual acuity is seen following such a treatment with no serious adverse effects. In the reported case, a full-thickness macular hole was noticed one month after intravitreal bevacizumab for macular edema secondary to hemicentral retinal vein occlusion.

Information transfer and communication in surgery: a systematic review.

Objectives: We conducted a systematic review of published literature to gain a better understanding of interprofessional information transfer and communication (ITC) in hospital setting in the field of surgical and anesthetic care.

Background: Communication breakdowns are a common cause of surgical errors and adverse events.

Data Sources: Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and hand search of articles bibliography.

An evaluation of information transfer through the continuum of surgical care: a feasibility study.

Objective: To evaluate information transfer and communication (ITC) across the surgical care pathway with the use of Information Transfer and Communication Assessment Tool for Surgery (ITCAS).

Background: Communication failures are the leading cause of surgical errors and adverse events. It is vital to assess the ITC across the entire surgical continuum of care to understand the process, to study teams, and to prioritize the phases for intervention.