The colorectal cancer multidisciplinary team and the interlinked role of the clinical nurse specialist

In order to continue to treat patients with colorectal cancer it is an official requirement (Peer Review Standard) that all cases are managed by a designated multidisciplinary team (MDT) which must meet regularly, usually weekly, to discuss them. This team must have written policies, it must keep records, and it must download them annually into the National Bowel Cancer Database (NBOCAP). There must be clinical nurse specialist input. This article summarizes best practice in all of these areas.     

Can we make airway management (even) safer?--lessons from national audit

The Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4) has published an extensive report examining both current practices in the United Kingdom regarding airway management during anaesthesia and the complications of airway management during anaesthesia and in intensive care units and emergency departments. The report makes more than 160 recommendations designed to improve care of patients. These recommendations have implications for individuals, departments, organisations and potentially for national policy in terms of training, standards of practice and the need for guidelines. The report also indicates several specific areas where future research might be directed. This article focuses on the implementation phase of NAP4, emphasising the importance of taking the lessons derived from NAP4 and turning them into actions to improve the safety of airway care delivered to patients, wherever in hospital this takes place.     

Mammoplasty with an L-shaped limited scar and retropectoral dermopexy

In mammoplasty the goal of the surgeon is giving the breast new form and volume and good, durable shape with minimal scarring. This article presents a simple technique of reduction mammoplasty that avoids incisions in the so-called hypertrophic areas of the chest, the medial and the lateral extremities of the submammary fold. The technique is based on nipple transposition on a superior semicircular flap in the new predetermined side, supra-areolar dermopexy. The skin of the inferior pole of the breast is internally de-epithelized to two curvilinear incisions that end near the projection of the anterior axillary line to form an inferior dermal flap for retropectoral dermopexy. The limited residual scar is L-shaped. Ptotic and hypertrophic breasts can be treated with this method.Presented at the XXXIVth National Congress of Italian Society of Plastic Surgery, Bari, 2–5 October 1985     

American Society of Nephrology Renal Research Report

In the spring of 2004, the Board of Advisors and the Council of the American Society of Nephrology believed it necessary to conduct a series of research retreats to steer priorities appropriately in an era of limited resources. In this regard, retreats were conducted by five working groups in areas that were identified to require distinct attention: acute renal failure, diabetic nephropathy, hypertension, transplantation, and uremic cardiovascular toxicity. The goal of each retreat was to join experts, both within and outside the renal community, to identify areas of basic science and clinical research that should receive highest priority in the next five years. The five retreat summaries with their individual listings of research priorities allow for the distillation of three overriding recommendations that strongly emanate from them: Continued support and expansion of investigator initiated research projects. In each of the five subjects on which this report is focused, there are areas of investigation that require the support of investigator-initiated projects if ultimately progress is to be made in the understanding of the basic mechanisms that underlie the diseases processes on which we want to have an impact in the next decade. It is recommended that there be an expansion of support for research in the areas highlighted in this report that lend themselves to this mechanism of funding by encouraging applications with appropriate program announcements and requests for proposals. In addition to vigorous support for RO1 grants, continued funding of Concept Development and R21/R33 grants is essential to support development of investigator-initiated clinical studies in these areas of high priority. Support for the development of a collaborative research infrastructure. The reader of this article cannot but be impressed by the common theme that independently emerged from each report regarding the urgent need to develop an infrastructure for kidney research. This infrastructure requires the development of core facilities for the centralized processing of biologic materials (genomics, proteomics, and metabolomics), in vivo imaging, development and distribution of antibodies and other molecular reagents, development and distribution and phenotyping of mouse models, and perhaps others. These need to be complemented with core bioinformatics centers that collect and analyze data and finally with a network of clinical study coordinating centers. Expansion of kidney research infrastructure can be achieved by vigorous funding of a program of kidney research core centers. Specifically, we propose that the number of kidney centers be increased with the goal of providing core facilities to support collaborative research on a local, regional, and national level. It should be emphasized that such a program of competitively reviewed kidney core centers would facilitate investigator-initiated research in both laboratory and patient-oriented investigation. This approach is also very much in line with the collaborative research enterprise conceived in the National Institutes of Health's Road Map. Support programs that have an impact on the understanding of the relationship between renal and cardiovascular disease (CVD). It is now widely recognized that chronic kidney dysfunction is an important risk factor for the development of CVD. It therefore is not surprising that essentially every one of the retreat reports emphasizes the urgency to examine this relationship. It is recommended that the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute (NHLBI) work cooperatively to support both basic and clinical science projects that will shed light on the pathogenesis of this relationship and to support the exploration of interventions that can decrease cardiovascular events in patients with chronic kidney disease. Thus, we specifically propose that the NHLBI support investigator-initiated research (RO1, Concept Development, and R21/R33) grants in areas of kidney research with a direct relationship to CVD. Similarly, the NHLBI should work collaboratively with the National Institute of Diabetes and Digestive and Kidney Diseases to support the proposed program of kidney core research centers. This subject provides an excellent opportunity to foment a collaboration between two institutes, along the lines of the present-day overall philosophy of the National Institutes of Health.     

Post-operative apnoea in the former preterm infant: a review

Former preterm infants are known to be at increased risk for apnoea, periodic breathing, and bradycardia. When surgery cannot be postponed until respiratory function is more mature, speical peri-operative considerations and measures are essential. In this article, the literature concerning this subject is reviewed, summarizing prospective and retrospective studies of risks associated with surgery in former preterm infants during the first year of life. This work is placed within the context of our ongoing studies of peri-operative risk in former preterm infants undergoing surgery at the Children's National Medical Center (CNMC), which have focused on three particular areas: (1) the effects of spinal versus general anaesthesia on the incidence of post-operative apnoea and bradycardia; (2) the possible contribution of anaemia of prematurity to surgical risk; and (3) the effect of peri-operative caffeine in preventing post-operative apnoea. Recommendations are made concerning surgical and anaesthetic management of infants who undergo surgery at < 44 weeks' post-conceptual age.     

Review of breast cancer clinical trials conducted by the National Surgical Adjuvant Breast Project

The National Surgical Adjuvant Breast Project (NSABP) is a clinical trials cooperative group funded by the National Cancer Institute that has been responsible for the majority of prospective, randomized studies that have defined standards of breast cancer care in the United States during the past 4 decades. This article summarizes the design of and findings from a selection of their landmark studies. Results from their many successfully completed trials have been reported as subset analyses, pooled analyses, and retrospective studies. This article focuses on presenting the study designs, aims, and primary endpoint results of these studies.     

General paediatric urology

Paediatric urological conditions range from those that are infrequent but severe and require referral to a specialist to those that may present to primary care physicians or adult urologists/general surgeons. The National Definitions Set No. 23 for Specialised Childrens' Services defines specialist paediatric urology. Adult general surgeons, adult urologists, general paediatric surgeons, general practitioners/primary care physicians, paediatricians and emergentologists will come across non-specialist or general paediatric urology which is referred to in this article. The management of paediatric urinary tract infection is beyond the scope of this article and readers are referred to recent guidelines issued by the National Institute for Health and Clinical Excellence. Management of common conditions and indications for specialist referral are addressed.     

Confidential enquiries into anaesthetic deaths

The purpose of confidential enquiries into anaesthetic deathshas been to identify the cause of death and find areas of substandardcare that might be amenable to correction. The enquiries withwhich anaesthetists in the UK have been most familiar with arethe Confidential Enquiries into Maternal Deaths (CEMD), theConfidential Enquiries into Stillbirths and Deaths in Infancy(CESDI), and the National Confidential Enquiries into PerioperativeDeaths (NCEPOD, now an acronym for National Confidential Enquiriesinto Perioperative Outcomes and Death). There is also a ConfidentialEnquiry into suicides and homicides. The organizations of CEMDand CESDI were taken over in 2003 by the Confidential Enquiriesinto Maternal and Child     

A review of reported litigation against English health trusts for the treatment of children in orthopaedics: present trends and suggestions to reduce mistakes

Purpose  

Large scale databases that offer a reflection of clinical negligence are rare. By assessing commonly occuring cases of negligence, we hope to highlight areas where pediatric orthopedic care might be improved. One such database is the National Health Service Litigation Authority, which deals with claims brought against all health trusts in England. By collating their data we aimed to highlight areas of commonly occurring clinical negligence and then suggest ways to avoid similar happening again.     

Executive Summary of the 2013 International Society for Clinical Densitometry Position Development Conference on Bone Densitometry

The International Society for Clinical Densitometry (ISCD) convenes a Position Development Conference (PDC) every 2–3 yr to make recommendations for guidelines and standards in the field of musculoskeletal measurement and assessment. The recommendations pertain to clinically relevant issues regarding the acquisition, quality control, interpretation, and reporting of various aspects of musculoskeletal health metrics. Topics for consideration are developed by the ISCD Board of Directors and the Scientific Advisory Committee. For the 2013 PDC, body composition analysis was a central topic area for the first time and considered timely because of the scientific advances in measurement of fat and lean body mass by dual-energy X-ray absorptiometry (DXA). Indications for DXA and vertebral fracture assessment and use of reference data to calculate bone mineral density T-scores were also updated. Task Forces for each of these areas were assigned questions of relevance to a clinical audience and asked to conduct comprehensive literature reviews. Reports with proposed Position Statements were then presented to an international panel of experts. The Expert Panel included representatives of the International Osteoporosis Foundation, the American Society for Bone and Mineral Research, the National Osteoporosis Foundation, Osteoporosis Canada, and the North American Menopause Society. The PDC was held in Tampa, FL, contemporaneously with the Annual Meeting of the ISCD, March 21 through March 23, 2013. This report describes the methodology of the 2013 ISCD PDC and summarizes the results of the 2013 ISCD PDC for vertebral fracture assessment/DXA and National Health and Nutrition Survey (NHANES) Reference Database Task Forces. A separate article in this issue will summarize the results of the Body Composition Analysis Task Forces.     

Looking back at the John Mitchell Crouch Fellowship: the most prestigious research award of the Royal Australasian College of Surgeons

The John Mitchell Crouch Fellowship is a generous endowment made to the Royal Australasian College of Surgeons (RACS) by the young neurosurgeon's family, following his death from a brain tumour. In this article, we examine the significance and legacy of the grant since its inception in 1979. This is the highest level of research fellowship awarded by the RACS recognizing early career excellence, as part of its significant research funding programme (over $1.7 million in 2015). John Mitchell Crouch recipients have been pioneers in various areas of medicine where they have developed new technologies, established research centres, improved patient safety and military surgery and embraced evidence‐based medicine. The funds they received have directly contributed to research published in numerous highly respected peer‐reviewed journals such as The New England Journal of Medicine; established new laboratories, helped fund clinical trials and allowed new directions of research to be pursued. Recipients of the John Mitchell Crouch Fellowship have been recognized with many awards including 11 Australian and New Zealand Honours to date. Many other significant research funds have been subsequently bestowed, including over 120 National Health Medical Research Council (NHMRC) grants to Australian and New Zealand recipients subsequent to their Fellowship. This article also shows the range of disciplines in which the award has supported cutting‐edge research leading to benefits for patients and health care.     

The internet as a tool for the renal community

The Internet has impacted health care. With the introduction of the personal health record (PHR), patients have an opportunity to track their physician visits, medications, and laboratory values online in a pleasant and informative learning environment. The PHR is a secure, online, Internet-accessible method of storing and easily retrieving health information about one's medical history, physician visits, laboratory values, and medications. The American Association of Kidney Patients (AAKP) has taken the leadership role in developing a PHR for patients of the kidney community. There are several barriers that patients experience when using the Web for health resources. These include inaccurate or self-serving information and marketing statements that can be misleading and dangerous. Poorly written or inappropriate information for patients can be problematic, as can an abundance of extraneous information. For the most part, the public often has no way to judge what is and is not credible based on the context of the article alone. This article gives the reader a review of several Web resources that are available for patients and also for renal professionals. They are largely from large nonprofit organizations like the AAKP, National Kidney Foundation, Medical Education Institute, American Society of Nephrology, or The Nephron Information Center (nephron.com). This article also reviews sites from The National Kidney Disease Education Program, Hypertension-Dialysis and Clinical Nephrology, National Institute of Diabetes and Digestive and Kidney Diseases, and DaVita.     

Does sex matter in musculoskeletal health? A workshop report

In April 2004, the American Academy of Orthopaedic Surgeons, the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH), and the Office of Research in Women's Health at the NIH convened a workshop to explore how male and female biologic and physiologic characteristics affect musculoskeletal health. This issue of Orthopedic Clinics of North America picks up where the workshop left off, extending the discussion of clinical topics across the broad spectrum of musculoskeletal health. This article serves as a prelude and introduction to the issue and provides a synopsis of the workshop findings.     

Evaluating quality in surgery

Defining, maintaining, and improving quality is essential to surgical practice. This article utilizes a leading quality assessment model and explores its relevance to the surgical community. National initiatives are discussed with critique of their effectiveness in improving clinical outcomes. Maintaining quality of care during crisis is addressed.     

Building the best portfolio for career progression

This article outlines the author's recommendations on accomplishing the best surgical portfolio to support successful career progression. The key areas covered are research, education, quality improvement, management skills, leadership development, clinical/operative experience and external interests. The article is intended to guide trainees towards a more balanced portfolio and offers hints and tips on how to enhance the key areas of the portfolio that often go undervalued.     

A comprehensive report on the experience of patients on continuous ambulatory peritoneal dialysis for the treatment of end-stage renal disease

This article summarizes highlights of data from the National Institutes of Health Continuous Ambulatory Peritoneal Dialysis Registry Report released in early 1984. Follow-up data for 6,656 patients were collected from January 1981 through June 1983 and were analyzed for this report.     

Balancing law,ethics and reality in informed consent for surgery

Informed consent has different implications and requirements in law and bioethics, and some irreconcilable disputes with the reality of surgical practice in the National Health Service. This article explores and discusses various aspects of informed consent that are of critical importance for practising surgeons in all specialties.     

Donor families, distinctive secondary losses, and "second death" experiences

Communication between donor families and the recipients of their loved ones' organs and tissues is a relatively new area of study. The National Kidney Foundation founded the National Donor Family Council in 1992 as a home for donor families. One of several items addressed by the Council was guidelines for communication, supporting the rights of donor families and recipients to communicate and build relationships should they choose to do so. Donation and transplant agencies play a strong role in facilitating and supporting donor families and recipients with these unique new relationships. This article offers 3 case examples of distinctive secondary losses and "second death" experiences encountered by some donor family members when the donation of tissues or organs they have authorized could not be used for transplantation, when those grafts fail or are rejected, or when the recipient dies. On that basis, the article explores the nature of these experiences and some reasons why they occur. Initial recommendations about how to address these experiences are provided. Finally, a 4-part agenda is suggested for research about (1) the nature of these distinctive secondary loss and second death experiences encountered by some donor families; (2) communications between donation and transplant professionals, on the one hand, and potential and actual donor family members, on the other hand; (3) the education, training, and support of professionals who provide bereavement support to donor family members; and (4) a review of the National Communication Guidelines.     

Improving continuing medical education: a valuable investment for the future of surgery

At present, surgery in Germany is suffering from the problem of poor attractivity jeopardizing nationwide availability of competent and high quality surgical care in the future. The causes for this have been repeatedly attributed to structural problems, above all in medical training and continuing medical education. In this article, we present the results of questionnaires of the National Society of German Surgeons and the German National Chamber of Physicians, identify the specific problem, and finally analyse them in an attempt to show how surgical training can be optimised and the attractivity of this specialty can be improved. In this context, the "Grosshadern Concept" for continuing surgical education is introduced as an example for an established and good functioning training curriculum.