AIM To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.METHODS Meta-analysis of randomised controlled trials and obse...AIM To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.METHODS Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. RESULTS A total of 36 studies(23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates(OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection(OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intraabdominal collection(OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality(OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation(OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay(overall mean difference 0.11 d, 95%CI:-0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlledtrials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. CONCLUSION In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.展开更多
AIM To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery,within an enhanced recovery protocol.METHODS Florence(FLO) is a...AIM To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery,within an enhanced recovery protocol.METHODS Florence(FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions,such as hypertension,using text-messaging.Newalgorithms were designed to monitor the well-being,basic physiological observations and any patient-reported symptoms,and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after discharge.All interactions with FLO and physiological readings were recorded and patients were invited to provide feedback.RESULTS Over a four-week period,16 out of 17 patients used the FLO telehealth service at home.These patients did not receive telephone follow-up at three days,as per our standard protocol,unless they reported being unwell or did not make use of the technology.Three patients were readmitted within 30 d,and two of these were identified as being unwell by FLO prior to readmission.No adverse events attributable to the use of the technology were encountered.CONCLUSION The utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is feasible.The use of this technology may assist in the early recognition and management of complications after discharge.展开更多
Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic ...Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic devices.ER procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness resection.Complete resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these goals.The EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such device.The EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA clearance.This review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.展开更多
Patient reported outcome measures(PROMs)provide a valuable means of measuring outcomes subjectively from a patient's perspective,facilitating the assessment of service quality across healthcare providers,and assis...Patient reported outcome measures(PROMs)provide a valuable means of measuring outcomes subjectively from a patient's perspective,facilitating the assessment of service quality across healthcare providers,and assisting patients and clinicians in shared decision making.The primary aim of this systematic review was to critically appraise all historic studies evaluating patient reported quality of life,in adult patients undergoing laparoscopic cholecystectomy for symptomatic gallstones.The secondary aim was to perform a quality assessment of cholecystectomy-specific PROM-validation studies.A literature review was performed in PubMed,Google ScholarTM,the Cochrane Library,Medline,CINAHL,EMBASE and PsychINFO databases up to September 2017.Study characteristics,PROM-specific details and a bias assessment were summarised for non-validation studies.A COnsensus-based Standards for the selection of health Measurement INstruments(COSMIN)analysis was performed to assess the methodological quality of identified PROM-validation studies.Fifty one studies were found to evaluate health-related quality of life(HRQoL)after laparoscopic cholecystectomy.Although 94.1%of these studies included PROMs as a primary outcome measure,<20%provided level 1 evidence through randomised controlled trials(RCTs).There was significant variation in the selection and reporting of PROMs,with no studies declaring patient involvement in PROM selection,and 88.2%of studies failing to document the management of missing data points,or non-returned surveys(33.3%).In the 6 PROM-validation studies identified,only 5 psychometric properties were evaluated,the findings of which were limited due to the small number of studies.This systematic review identifies a lack in consistency of study design and PRO reporting in clinical trials.Whilst an increasing number of studies are being performed to evaluate PROs,a lack of adherence to existing PRO administration and reporting guidelines is continuing to negatively affect study quality.We recommend that future clinical trials utilizing PROs should adhere to established comprehensive guidelines as described.展开更多
Ana M Valdes及同事探讨了通过饮食和益生菌调节肠道微生物群的策略。微生物基因组(Microbiome)是指在特定环境中微生物的基因组集合,而微生物群(Microbiota)是指微生物自身组成的群落(译者注:国内文献通常将微生物群称为菌群,微生物基...Ana M Valdes及同事探讨了通过饮食和益生菌调节肠道微生物群的策略。微生物基因组(Microbiome)是指在特定环境中微生物的基因组集合,而微生物群(Microbiota)是指微生物自身组成的群落(译者注:国内文献通常将微生物群称为菌群,微生物基因组称为微生物组)(框图1)。约有100万亿微生物(大多数是细菌,也有病毒、真菌和原生动物)存在于人体胃肠道中1-2。展开更多
WHAT IS ALREADY KNOWN Recently published summaries and meta-analyses of four randomised controlled trials(RCTs)1-5 comparing direct mechan-ical thrombectomy(dMT)and bridging therapy with intravenous(IV)thrombolytics(a...WHAT IS ALREADY KNOWN Recently published summaries and meta-analyses of four randomised controlled trials(RCTs)1-5 comparing direct mechan-ical thrombectomy(dMT)and bridging therapy with intravenous(IV)thrombolytics(alteplase)suggested that dMT is non-inferior to bridging therapy to achieve good functional outcome 3 months after stroke(modified Rankin Score 0-2)with the non-inferiority margin(NIM)<−5%.展开更多
Chronic hepatitis C virus(HCV)infection frequently leads to liver cirrhosis(1),which is a major risk factor for hepatocellular carcinoma(HCC)and liver failure.Together,these two complications account for nearly half a...Chronic hepatitis C virus(HCV)infection frequently leads to liver cirrhosis(1),which is a major risk factor for hepatocellular carcinoma(HCC)and liver failure.Together,these two complications account for nearly half a million HCV-related deaths every year,world-wide(2).In contrast to other blood borne viruses such as HIV and hepatitis B,chronic HCV is a curable infection.Yet until recently,few HCV cirrhosis patients were able to achieve a cure because standard-of-care therapies were ineffective(<30%chance of cure)and entailed significant adverse effects(3).展开更多
文摘AIM To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.METHODS Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. RESULTS A total of 36 studies(23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates(OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection(OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intraabdominal collection(OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality(OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation(OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay(overall mean difference 0.11 d, 95%CI:-0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlledtrials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. CONCLUSION In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.
文摘AIM To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery,within an enhanced recovery protocol.METHODS Florence(FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions,such as hypertension,using text-messaging.Newalgorithms were designed to monitor the well-being,basic physiological observations and any patient-reported symptoms,and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after discharge.All interactions with FLO and physiological readings were recorded and patients were invited to provide feedback.RESULTS Over a four-week period,16 out of 17 patients used the FLO telehealth service at home.These patients did not receive telephone follow-up at three days,as per our standard protocol,unless they reported being unwell or did not make use of the technology.Three patients were readmitted within 30 d,and two of these were identified as being unwell by FLO prior to readmission.No adverse events attributable to the use of the technology were encountered.CONCLUSION The utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is feasible.The use of this technology may assist in the early recognition and management of complications after discharge.
文摘Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic devices.ER procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness resection.Complete resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these goals.The EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such device.The EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA clearance.This review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.
基金the Medical Research Council(grant number MR/K00414X/1)ArthritisResearch UK[grant number 19891].Prita Daliya is a recipient of a Research Fellowship funded by the Royal College of Surgeons of England and EIDO Healthcare Limited.
文摘Patient reported outcome measures(PROMs)provide a valuable means of measuring outcomes subjectively from a patient's perspective,facilitating the assessment of service quality across healthcare providers,and assisting patients and clinicians in shared decision making.The primary aim of this systematic review was to critically appraise all historic studies evaluating patient reported quality of life,in adult patients undergoing laparoscopic cholecystectomy for symptomatic gallstones.The secondary aim was to perform a quality assessment of cholecystectomy-specific PROM-validation studies.A literature review was performed in PubMed,Google ScholarTM,the Cochrane Library,Medline,CINAHL,EMBASE and PsychINFO databases up to September 2017.Study characteristics,PROM-specific details and a bias assessment were summarised for non-validation studies.A COnsensus-based Standards for the selection of health Measurement INstruments(COSMIN)analysis was performed to assess the methodological quality of identified PROM-validation studies.Fifty one studies were found to evaluate health-related quality of life(HRQoL)after laparoscopic cholecystectomy.Although 94.1%of these studies included PROMs as a primary outcome measure,<20%provided level 1 evidence through randomised controlled trials(RCTs).There was significant variation in the selection and reporting of PROMs,with no studies declaring patient involvement in PROM selection,and 88.2%of studies failing to document the management of missing data points,or non-returned surveys(33.3%).In the 6 PROM-validation studies identified,only 5 psychometric properties were evaluated,the findings of which were limited due to the small number of studies.This systematic review identifies a lack in consistency of study design and PRO reporting in clinical trials.Whilst an increasing number of studies are being performed to evaluate PROs,a lack of adherence to existing PRO administration and reporting guidelines is continuing to negatively affect study quality.We recommend that future clinical trials utilizing PROs should adhere to established comprehensive guidelines as described.
文摘Ana M Valdes及同事探讨了通过饮食和益生菌调节肠道微生物群的策略。微生物基因组(Microbiome)是指在特定环境中微生物的基因组集合,而微生物群(Microbiota)是指微生物自身组成的群落(译者注:国内文献通常将微生物群称为菌群,微生物基因组称为微生物组)(框图1)。约有100万亿微生物(大多数是细菌,也有病毒、真菌和原生动物)存在于人体胃肠道中1-2。
文摘WHAT IS ALREADY KNOWN Recently published summaries and meta-analyses of four randomised controlled trials(RCTs)1-5 comparing direct mechan-ical thrombectomy(dMT)and bridging therapy with intravenous(IV)thrombolytics(alteplase)suggested that dMT is non-inferior to bridging therapy to achieve good functional outcome 3 months after stroke(modified Rankin Score 0-2)with the non-inferiority margin(NIM)<−5%.
文摘Chronic hepatitis C virus(HCV)infection frequently leads to liver cirrhosis(1),which is a major risk factor for hepatocellular carcinoma(HCC)and liver failure.Together,these two complications account for nearly half a million HCV-related deaths every year,world-wide(2).In contrast to other blood borne viruses such as HIV and hepatitis B,chronic HCV is a curable infection.Yet until recently,few HCV cirrhosis patients were able to achieve a cure because standard-of-care therapies were ineffective(<30%chance of cure)and entailed significant adverse effects(3).
