Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI).

Purpose: Gastrointestinal (GI) dysfunction is common in critically ill patients and associated with poor outcomes. There is a lack of standardised methods for daily monitoring of GI function. COSMOGI aimed to develop a Core Outcome Set (COS) for daily monitoring of GI function to improve consistency and comparability in future studies in critically ill patients.

Collision tumor comprised of chronic lymphocytic leukemia and myxopapillary ependymoma.

Background: Collision tumors involving the co-occurrence of two morphologically and genomically distinct neoplasms in the same anatomical site are exceptionally rare in the central nervous system (CNS).

Case Description: We report a unique case of a CNS collision tumor comprising chronic lymphocytic leukemia and myxopapillary ependymoma in a 77-year-old male with acute neurological decline. Presumed to represent leukemic infiltration, urgent laminectomy was pursued for tissue diagnosis and spinal cord decompression, revealing the unexpected ependymal component.

Fatal drug reaction to andexanet alfa: a case report.

Andexanet alfa is a recombinant, modified factor Xa (FXa) molecule that is used for the reversal of the anticoagulant effect of oral anti-FXa anticoagulants in patients with major haemorrhage. Here, we present a case of an 85-year-old man taking rivaroxaban for atrial fibrillation, who presented with an acute, upper gastrointestinal bleed. He was stabilised with red cell transfusion and then received a 400 mg bolus of andexanet alfa.

Multivariable prognostic modelling to improve prediction of colorectal cancer recurrence: the PROSPeCT trial.

Objective: Improving prognostication to direct personalised therapy remains an unmet need. This study prospectively investigated promising CT, genetic, and immunohistochemical markers to improve the prediction of colorectal cancer recurrence.

Material And Methods: This multicentre trial (ISRCTN 95037515) recruited patients with primary colorectal cancer undergoing CT staging from 13 hospitals.

Retrograde Ureteral Stents Versus Percutaneous Nephrostomy in the Management of Malignant Ureteral Obstruction: A Systematic Review and Meta-Analysis.

Objective: To evaluate outcomes in cancer patients with ureteral obstruction by comparison of retrograde stenting and percutaneous nephrostomy techniques.

Methods: Systematic review of all studies up to October 2023. Studies were identified from all major databases including MEDLINE, Cochrane, and EMBASE.

Performance Characteristics and Limitations of the Available Assays for the Detection and Quantitation of Monoclonal Free Light Chains and New Emerging Methodologies.

Light chain measurements form an essential component of the testing strategy for the detection and monitoring of patients with suspected and/or proven plasma cell disorders. Urine-based electrophoretic assays remain at the centre of the international guidelines for response assessment but the supplementary role of serum-free light chain (FLC) assays in response assessment and the detection of disease progression due to their increased sensitivity has been increasingly recognised since their introduction in 2001. Serum FLC assays have also been shown to be prognostic across the spectrum of plasma cell disorders and are now incorporated into risk stratification scores for patients with monoclonal gammopathy of undetermined significance (MGUS), smouldering multiple myeloma, and light chain amyloidosis (AL amyloidosis), as well as being incorporated into the criteria for defining symptomatic multiple myeloma.

A customized technique for confluent aortic annular and selective sinus of Valsalva endocarditis.

We describe a novel technical modification for reoperative aortic valve replacement in destructive recurrent prosthetic aortic valve endocarditis. We encountered complex anatomy in a previously operated aortic root wherein the aortic annulus and the right coronary sinus of Valsalva were destroyed. This precluded secure suture placement.

Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial.

Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients' own words at diagnosis and included diagnostic time intervals.

Interventricular septal mass with coronary artery disease-An unusual presentation in a septuagenarian patient.

A 79-year-old male with a history of syncope attack was found to have a mass in the interventricular septum. The tumor was surgically removed, and the histological diagnosis was ectopic thyroid tissue. The outcome of the surgery was expected to be successful, however, the patient died from multiorgan failure.

Airway management, intensive care requirement, and corticosteroid use in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) study.

Cervicofacial infection (CFI) is a frequently encountered presentation to Oral and Maxillofacial Departments (OMFS). The United Kingdom has recently seen cessation of all routine community dental treatment due to the Coronavirus (COVID-19) pandemic and consequently an initial modification of treatment received in secondary care. Subsequent airway difficulties and the need for level 2 High Dependency Unit (HDU) or level 3 Intensive Care Unit (ICU) is a concern to surgeons and anaesthetists alike.

Widening access to the specialised foundation programme.

The specialised foundation programme, previously known as the academic foundation programme, is an alternate foundation training pathway for doctors that are interested in research, medical education and leadership. The programme is highly competitive, with competition ratios rising to 1:5 in some units of application. A series of courses is held each year out of goodwill to assist students with the application process, but little has been published with respect to evidence-based approaches to both the application process and interviews.

Mechanical dilatation of the stenosed cervix under local anesthesia: A prospective case series.

Aim: Cervical stenosis is traditionally managed by mechanical dilatation under general anesthesia (GA). We aimed to assess the safety, effectiveness, and patient acceptability of dilatation in the outpatient setting under local anesthesia (LA).

Methods: Data were collected prospectively from all patients attending the outpatient department with cervical stenosis from March 20, 2015 to September 23, 2020.

Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial.

Background: Myeloma causes profound immunodeficiency and recurrent, serious infections. Around 5500 new cases of myeloma are diagnosed per year in the UK, and a quarter of patients will have a serious infection within 3 months of diagnosis. We aimed to assess whether patients newly diagnosed with myeloma benefit from antibiotic prophylaxis to prevent infection, and to investigate the effect on antibiotic-resistant organism carriage and health care-associated infections in patients with newly diagnosed myeloma.

Needs-based quality of life in adults dependent on home parenteral nutrition.

Background & Aims: Home parenteral nutrition (HPN) provides life sustaining treatment for people with chronic intestinal failure. Individuals may require HPN for months or years and are dependent on regular intravenous infusions, usually 12-14 h overnight between 1 and 7 days each week. This regime can have adverse impact on the life of people dependent on the treatment.

Effectiveness of Intra-Gastric Balloon as a Bridge to Definitive Surgery in the Super Obese.

Background: British National guidelines (NICE) recommend bariatric surgery for patients with a body mass index (BMI) > 40 kg/m2, or BMI > 35 kg/m2 with any comorbidities of the metabolic syndrome. Intra-gastric balloons (IGB) can be used in super obese patients as a first step, before definitive surgery.

Aims: Quantify weight loss 6 months after IGB placement, measure progression to definitive surgery and identify complications.

A reflective qualitative appreciative inquiry approach to restoring compassionate care deficits at one United Kingdom health care site.

Background: Following declining health care practices at one UK health care site the subsequent and much publicized Francis Report made several far-reaching recommendations aimed at recovering optimal levels of care including stringent monitoring of practice. The aftermath of these deliberations have had resounding consequences for quality care both nationally and internationally.

Design: A reflective qualitative appreciative qualitative inquiry using a hybrid approach combining case study and thematic analysis outlines the development and analysis of a solution-focused intervention aimed at restoring staff confidence and optimal care levels at one key UK hospital site.

Achieving a Successful Closure of an Anterior Tympanic Membrane Perforation: Evidence-Based Systematic Review.

Objectives Surgical repair of a tympanic membrane perforation is a common otologic procedure. However, achieving a successful closure can be challenging, especially if the anterior margin of the tympanic membrane is involved. The aim of this study was to systematically review the literature on evidence published in closure of anterior tympanic membrane perforations.

Radiographic morphology of normal ring apophyses in the immature cervical spine.

Background: The ring apophyses of the cervical spine have a variable appearance that changes with age. The times at which they appear and fuse at each level are not fixed. In this study, we aim to detail normal ranges of appearance of these ossification centers for each age group.

Editor's Choice - Self-referral to the NHS Abdominal Aortic Aneurysm Screening Programme.

Introduction: The NHS Abdominal Aortic Screening Programme (NAAASP) invites men in their 65th year for screening, men over 65 may self-refer into the programme. Most studies have concentrated on those invited for screening, little is known about the self-referral group. Our aim was to provide a descriptive analysis of the men who self refer to NAAASP for screening.

Neck stoma patients: is vital information displayed at the bedside?

Tracheostomies are common procedures in head and neck and critical care practice, with 50% of airway-related deaths attributable to complications such as occlusion or displacement. The National Tracheostomy Safety Project (NTSP) published guidance regarding emergency management of neck stoma patients. A prospective multicentre regional audit of all neck stoma inpatients (ward and intensive care unit (ICU) settings) was conducted.

Tongue-tie assessment and division: a time-critical intervention to optimise breastfeeding.

Objectives: Recent reports have highlighted the benefits of surgical division of tongue-tie (frenulotomy) in infants with breastfeeding difficulties. There is no clear consensus defining the appropriate age for this procedure to be undertaken in selected infants. We aimed to evaluate the impact of delays in time between referral and frenulotomy in relation to maternal abandonment of breastfeeding.