Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients’ well-... more Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients’ well-being. Strict fasting protocol has been used prior to OGDS with the concern of reduced visibility or suboptimal endoscopic assessment. Maltodextrin beverages were also commonly used as the pre-operative carbohydrate loading in enhanced recovery after surgery (ERAS) protocol. Our study aimed to look for the effects of maltodextrin beverage 2 h before OGDS on gastric residual volume and patient’s well-being scores. This was a single-blinded, stratified randomised controlled trial, comparing control group (A, received 400 ml of plain water) and carbohydrate loading group (B, received 400 ml of Carborie). The primary objectives were to measure the gastric residual volume (GRV) and patient’s well-being scores using visual analogue scale (VAS) scores for hunger, thirst, anxiety, tiredness and general discomfort. Of 80 randomised patients, 78 completed the study (38 received plain water and 40 ...
Background: Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to pat... more Background: Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients well-being. Aims:To determine the effect of maltodextrin beverage 2 hours before OGDS on gastric residual volume and patient’s well-being scores. Methods: A single-blinded, stratified randomised controlled trial was performed, comparing control group (A, received 400 ml of plain water) and carbohydrate loading group (B, received 400 ml of Carborie®) in terms of gastric residual volume (GRV) and patient’s well-being scores (visual analogue scale (VAS)) scores for hunger, thirst, anxiety, tiredness and general discomfort). Results: Of 80 randomised patients, 78 completed the study (38 received plain water and 40 Carborie®). The median (IQR) GRV was not significantly different between group A and B (5.0 ml (20) vs 4.0 ml (19)), p= 0.777). Both groups showed significant reduction in VAS scores in all five parameters (p≤ 0.001). There were no complications attributed to endoscopy in eit...
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Background: The thyroid imaging and reporting data system (TIRADS) has been routinely used to rep... more Background: The thyroid imaging and reporting data system (TIRADS) has been routinely used to report thyroid nodules since its introduction in 2017. Similarly, the Bethesda system is a well-validated method used to report the cytopathology of thyroid lesions for over a decade. The aim of this study was to investigate the correlations between these two systems. Methods: This retrospective cohort study comprised patients who underwent ultrasound assessments of the thyroid gland followed by fine needle aspiration cytology (FNAC) of the thyroid nodules at a teaching hospital. The variables were categorised into ultrasound and cytological findings, and the outcomes measured from the two systems (validity of the system and risk of malignancy in each group of thyroid nodules) were correlated. Spearman’s correlation was used to determine the correlation, and the Kappa test was used to determine the agreement between the systems. Results: A total of 295 patients who fulfilled the inclusion c...
Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of ... more Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involvin...
Colorectal carcinoma (CRC) rarely metastasizes to the urinary system in isolated form. It usually... more Colorectal carcinoma (CRC) rarely metastasizes to the urinary system in isolated form. It usually spreads through direct invasion with intra-ureteric growth or local ureter mucosal metastasis without involving the muscular layer. We present a case of a 63-year-old man who came with uraemic symptoms and a ballotable right kidney. Laboratory and imaging showed acute renal failure with right renal mass suspicious of malignancy and left ureteric stricture causing hydronephrosis. He underwent right radical nephrectomy and left open ureteric stenting plus biopsy sampling. Adenocarcinoma was detected through the evaluation of the specimen. In view that adenocarcinoma rarely occurs in the urinary system, an investigation was carried out to search for the primary source. Colonoscopy was performed, which later showed adenocarcinoma of the rectum. Adenocarcinoma in the renal system should always raise the suspicion of another primary source of malignancy, especially colorectal origin. The adva...
BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on h... more BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic ‘wave’.MethodsAn online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale.ResultsThe survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms cancelling all ‘elective’ repairs. For patients with symptomatic peripheral arterial disease 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm repair, 31.8% o...
Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based app... more Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidel...
BackgroundBreast cancer is the most common cancer in women worldwide. Early detection and interve... more BackgroundBreast cancer is the most common cancer in women worldwide. Early detection and intervention are associated with better prognosis and survival. The study aim was to investigate the factors associated with delayed presentation among women with breast symptoms.MethodsAfter ethics approval, a cross-sectional study was conducted from January to October 2020 in women with new breast cancer symptoms at their first visit to our clinic. The “Delayed Presentation” questionnaires in the Malay language were used and distributed among the participants. Demographic data and presentation time were recorded. Presentation time was defined as the duration of symptoms prior to visiting any health care facilities. Respondents with presentation times > 90 days comprised the delayed group. The potential factors associated with the delayed presentation were analyzed using cross-tabulation and multiple logistic regression.ResultsThere were 106 respondents to the questionnaire, with a mean age...
Traumatic liver injury can be classified by grading using American Association with Surgery Traum... more Traumatic liver injury can be classified by grading using American Association with Surgery Trauma (AAST). We presented a case of a 22-year-old female who had a motor vehicle accident and sustained a stable Grade 4 liver injury. An angioembolization was performed by the interventional radiologist team, which successfully occluded all the extravasation of the bleed. If the patient is hemodynamically stable in high grade or bleeding liver injury, a non-invasive technique such as angioembolization could be practiced at the bleeding site to minimize or stop the bleeding.
Background: Breast cancer is the most common cancer in women worldwide. Early detection and inter... more Background: Breast cancer is the most common cancer in women worldwide. Early detection and intervention are associated with better prognosis and survival. The study aim was to investigate the factors associated with delayed treatment among women with breast symptoms.Methods: After ethics approval, a cross-sectional study was conducted from January to October 2020 in women with new breast cancer symptoms at their first visit to our clinic. The “Delayed Presentation” questionnaires in the Malay language were used and distributed among the participants. Demographic data and presentation time were recorded. Presentation time was defined as the duration of symptoms prior to visiting the clinic. Respondents with presentation times > 90 days comprised the delayed group. The potential factors associated with delayed presentation were analyzed using cross-tabulation and multiple logistic regression.Results: There were 106 respondents to the questionnaire, with a mean age of 34.0 (SD: 11....
Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients’ well-... more Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients’ well-being. Strict fasting protocol has been used prior to OGDS with the concern of reduced visibility or suboptimal endoscopic assessment. Maltodextrin beverages were also commonly used as the pre-operative carbohydrate loading in enhanced recovery after surgery (ERAS) protocol. Our study aimed to look for the effects of maltodextrin beverage 2 h before OGDS on gastric residual volume and patient’s well-being scores. This was a single-blinded, stratified randomised controlled trial, comparing control group (A, received 400 ml of plain water) and carbohydrate loading group (B, received 400 ml of Carborie). The primary objectives were to measure the gastric residual volume (GRV) and patient’s well-being scores using visual analogue scale (VAS) scores for hunger, thirst, anxiety, tiredness and general discomfort. Of 80 randomised patients, 78 completed the study (38 received plain water and 40 ...
Background: Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to pat... more Background: Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients well-being. Aims:To determine the effect of maltodextrin beverage 2 hours before OGDS on gastric residual volume and patient’s well-being scores. Methods: A single-blinded, stratified randomised controlled trial was performed, comparing control group (A, received 400 ml of plain water) and carbohydrate loading group (B, received 400 ml of Carborie®) in terms of gastric residual volume (GRV) and patient’s well-being scores (visual analogue scale (VAS)) scores for hunger, thirst, anxiety, tiredness and general discomfort). Results: Of 80 randomised patients, 78 completed the study (38 received plain water and 40 Carborie®). The median (IQR) GRV was not significantly different between group A and B (5.0 ml (20) vs 4.0 ml (19)), p= 0.777). Both groups showed significant reduction in VAS scores in all five parameters (p≤ 0.001). There were no complications attributed to endoscopy in eit...
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Background: The thyroid imaging and reporting data system (TIRADS) has been routinely used to rep... more Background: The thyroid imaging and reporting data system (TIRADS) has been routinely used to report thyroid nodules since its introduction in 2017. Similarly, the Bethesda system is a well-validated method used to report the cytopathology of thyroid lesions for over a decade. The aim of this study was to investigate the correlations between these two systems. Methods: This retrospective cohort study comprised patients who underwent ultrasound assessments of the thyroid gland followed by fine needle aspiration cytology (FNAC) of the thyroid nodules at a teaching hospital. The variables were categorised into ultrasound and cytological findings, and the outcomes measured from the two systems (validity of the system and risk of malignancy in each group of thyroid nodules) were correlated. Spearman’s correlation was used to determine the correlation, and the Kappa test was used to determine the agreement between the systems. Results: A total of 295 patients who fulfilled the inclusion c...
Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of ... more Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involvin...
Colorectal carcinoma (CRC) rarely metastasizes to the urinary system in isolated form. It usually... more Colorectal carcinoma (CRC) rarely metastasizes to the urinary system in isolated form. It usually spreads through direct invasion with intra-ureteric growth or local ureter mucosal metastasis without involving the muscular layer. We present a case of a 63-year-old man who came with uraemic symptoms and a ballotable right kidney. Laboratory and imaging showed acute renal failure with right renal mass suspicious of malignancy and left ureteric stricture causing hydronephrosis. He underwent right radical nephrectomy and left open ureteric stenting plus biopsy sampling. Adenocarcinoma was detected through the evaluation of the specimen. In view that adenocarcinoma rarely occurs in the urinary system, an investigation was carried out to search for the primary source. Colonoscopy was performed, which later showed adenocarcinoma of the rectum. Adenocarcinoma in the renal system should always raise the suspicion of another primary source of malignancy, especially colorectal origin. The adva...
BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on h... more BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic ‘wave’.MethodsAn online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale.ResultsThe survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms cancelling all ‘elective’ repairs. For patients with symptomatic peripheral arterial disease 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm repair, 31.8% o...
Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based app... more Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidel...
BackgroundBreast cancer is the most common cancer in women worldwide. Early detection and interve... more BackgroundBreast cancer is the most common cancer in women worldwide. Early detection and intervention are associated with better prognosis and survival. The study aim was to investigate the factors associated with delayed presentation among women with breast symptoms.MethodsAfter ethics approval, a cross-sectional study was conducted from January to October 2020 in women with new breast cancer symptoms at their first visit to our clinic. The “Delayed Presentation” questionnaires in the Malay language were used and distributed among the participants. Demographic data and presentation time were recorded. Presentation time was defined as the duration of symptoms prior to visiting any health care facilities. Respondents with presentation times > 90 days comprised the delayed group. The potential factors associated with the delayed presentation were analyzed using cross-tabulation and multiple logistic regression.ResultsThere were 106 respondents to the questionnaire, with a mean age...
Traumatic liver injury can be classified by grading using American Association with Surgery Traum... more Traumatic liver injury can be classified by grading using American Association with Surgery Trauma (AAST). We presented a case of a 22-year-old female who had a motor vehicle accident and sustained a stable Grade 4 liver injury. An angioembolization was performed by the interventional radiologist team, which successfully occluded all the extravasation of the bleed. If the patient is hemodynamically stable in high grade or bleeding liver injury, a non-invasive technique such as angioembolization could be practiced at the bleeding site to minimize or stop the bleeding.
Background: Breast cancer is the most common cancer in women worldwide. Early detection and inter... more Background: Breast cancer is the most common cancer in women worldwide. Early detection and intervention are associated with better prognosis and survival. The study aim was to investigate the factors associated with delayed treatment among women with breast symptoms.Methods: After ethics approval, a cross-sectional study was conducted from January to October 2020 in women with new breast cancer symptoms at their first visit to our clinic. The “Delayed Presentation” questionnaires in the Malay language were used and distributed among the participants. Demographic data and presentation time were recorded. Presentation time was defined as the duration of symptoms prior to visiting the clinic. Respondents with presentation times > 90 days comprised the delayed group. The potential factors associated with delayed presentation were analyzed using cross-tabulation and multiple logistic regression.Results: There were 106 respondents to the questionnaire, with a mean age of 34.0 (SD: 11....
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