The Impact of Centralised Services on Metric Reflecting High-quality Performance: Outcomes from 1110 Consecutive Radical Cystectomies at a Single Centre.

Background: The 2002 National Institute for Health and Care Excellence guidance on centralisation of radical cystectomy (RC) coincided with changes in practice: use of neoadjuvant chemotherapy (NAC) and pelvic lymph node dissection (PLND), and RC for high-risk non-muscle-invasive bladder cancer (HR-NMIBC).

Objective: To report the outcomes of RC at a single centre and to compare trends in survival with respect to centralisation and change in RC practice.

Design, Setting, And Participants: Data were collected retrospectively between 1 January 1994 and 31 December 2016.

British Society of Echocardiography Departmental Accreditation Standards 2019 with input from the Intensive Care Society.

This article sets out a summary of standards for departmental accreditation set by the British Society of Echocardiography (BSE) Departmental Accreditation Committee. Full accreditation standards are available at www.bsecho.

Physiotherapists deliver management broadly consistent with recommended practice in rotator cuff tendinopathy: An observational study.

Background: Rotator cuff tendinopathy is a common and disabling cause of shoulder pain. While conservative treatment is recommended as initial management, recent findings suggest that general practitioners and rheumatologists do not consistently align with recommended care. This study aimed to survey Australian physiotherapists to explore the extent to which recommended management is being applied.

Education and Training in Breast Cancer Surgery in Europe.

Background: The substantial increase in the complexity of breast cancer care in the last few decades has resulted in significant improvements in survival rates and also in the quality of life of breast cancer survivors. However, across Europe there are variations in outcomes and access to the latest techniques. Whilst much of this variance is due to differences in health economies between European member states, training variation may also play a part.

European Guidelines on the Organisation of Breast Centres and Voluntary Certification Processes.

Background: EUSOMA undertook the commitment of defining the requirements for a specialist breast centre, which has become the reference document for the implementation of breast centres.

Summary: The EUSOMA requirements for a specialist breast centre give clear indications regarding the requisite caseload, dedicated team composition (core and non-core team), organisation, availability of services and equipment throughout the patient pathway, quality control, and application of a multidisciplinary approach. The minimum number of cases is 150 newly diagnosed breast cancer cases per year.

Effects of the Care Certificate on healthcare assistants' ability to identify and manage deteriorating patients.

The Care Certificate, launched in England in 2015, safeguards patients by ensuring all new healthcare assistants (HCAs) undertake a structured educational programme so that they can provide appropriate, safe and high standards of care in clinical settings. This article describes a service evaluation that aimed to identify the effects of the Care Certificate on HCAs' confidence and ability to identify, and initiate management of, unwell patients independently.

Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit.

Objective: The aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes.

Design: Prospective cohort study.

Setting: 131 UK hospitals with acute surgical services.

What Every Bariatric Surgeon Should Know: How to Relieve Obstruction at the Jejuno-jejunostomy After Roux-en-Y Gastric Bypass.

Introduction: Roux-en-Y gastric bypass (RYGB) remains one of the key bariatric procedures worldwide. In addition to bleeding and anastomotic leak, there are rarely occurring complications such as obstruction at the jejuno-jejunostomy in the early postoperative phase.

Patient And Methods: A 51-year-old lady (weight 122 kg; BMI 46 kg/m; with type 2 diabetes mellitus and hypertension) underwent RYGB in our tertiary referral centre 3 days prior to admission.

Rotator CUFF disorders: A survey of current physiotherapy practice in Belgium and the Netherlands.

Background: Disorders of the rotator cuff are a common musculoskeletal pain presentation in the general population, and treatment by a physiotherapist is often prescribed. In 2011, 2016, surveys of physiotherapy practice in the United Kingdom (UK) were performed, which reported that advice and exercise were the most common treatment strategies used. The aim of this current survey was to examine current physiotherapy practice in Belgium and The Netherlands, with consideration of differences between physiotherapists who were members of a shoulder network and physiotherapists who were not.

European Society of Surgical Oncology's strategy for clinical research: Paving the way for a culture of research in cancer surgery.

As part of its mission to promote the best surgical care for cancer patients, the European Society of Surgical Oncology (ESSO) has been developing multiple programmes for clinical research along with its educational portfolio. This position paper describes the different research activities of the Society over the past decade and an action plan for the upcoming five years to lead innovative and high quality surgical oncology research. ESSO proposes to consider pragmatic research methodologies as a complement to randomised clinical trials (RCT), advocates for increased funding and operational support in conducting research and aims to enable young surgeons to be active in research and establish partnerships for translational research activities.

Face and Neck Lift-Postoperative Care.

Primary aim of the article is a discussion of the postoperative care after face and neck lift. A brief history of face and neck lift along with different techniques are described. Importance of preoperative assessment is stressed.

Glycosylated haemoglobin: a false sense of security.

We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test.

Optic neuritis as presenting primary hypoparathyroidism.

Papilloedema and raised intracranial pressure have been frequently reported with hypoparathyroidism, but very rarely optic neuritis. We report a case of a 54-year-old male patient who presented with classical optic neuritis which is believed to be secondary to primary hypoparathyroidism.

Obstructive Sleep Apnoea Screening Preoperatively with the Epworth Questionnaire: Is It Worth It…?

Background: The prevalence of obstructive sleep apnoea (OSA) in the bariatric population has been reported to be as high as 60-83%. The Epworth Sleepiness Scale (ESS) is a validated, self-administrated eight-item questionnaire that measures subjective daytime sleepiness and thus helps to identify high-risk for OSA.

Objectives: To find the prevalence of OSA in patients undergoing bariatric surgery who do not routinely undergo polysomnography (PSG) and are screened by the ESS.

European Breast Cancer Council manifesto 2018: Genetic risk prediction testing in breast cancer.

European Breast Cancer Council manifesto and supporting article on genetic risk prediction testing in breast cancer, presented at the 11th European Breast Cancer Conference in Barcelona, Spain.

Percutaneous cholecystostomy… why, when, what next? A systematic review of past decade.

Introduction: Percutaneous cholecystostomy tube drainage has played a vital role in management of cholecystitis in patients where surgery is not appropriate. However, management differs from unit to unit and even between different consultants in the same unit. We conducted this systematic review to understand which of these resulted in the best patient outcomes.

An overview of realist evaluation for simulation-based education.

This article describes the key features of realist (realistic) evaluation and illustrates their application using, as an example, a simulation-based course for final year medical students. The use of simulation-based education (SBE) is increasing and so too is the evidence supporting its value as a powerful technique which can lead to substantial educational benefits. Accompanying these changes is a call for research into its use to be more theory-driven and to investigate both 'Did it work?' and as importantly 'Why did it work (or not)?' An evaluation methodology that is capable of answering both questions is realist evaluation.

Postpartum pneumomediastinum and subcutaneous emphysema.

We present the case of a 22-year-old primigravida with symptoms of neck swelling and difficulty breathing 3 hours after uneventful vaginal delivery. On examination, there was surgical emphysema. A CT scan confirmed air in the subcutaneous tissues and also revealed pneumomediastinum.

A Rare Pathology of Difficult Laparoscopic Cholecystectomy: Xanthogranulomatous Cholecystitis.

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory condition of the gallbladder (GB). Preoperatively, it is a diagnostic challenge. One thousand and seventy nine laparoscopic cholecystectomy (LC) patients from September 2012 to June 2015 were retrospectively reviewed.

What Imaging-Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review.

Objective: Shoulder symptoms are common, and imaging is being increasingly used to help with management. However, the relationship between imaging and symptoms remains unclear. This review aims to understand the relationship between imaging-detected pathologies, symptoms, and their persistence.