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Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies

Objectives To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence and deaths.  
bmj.com
over 5 years ago
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36

Arthroscopy for degenerate meniscal tears of the knee

The NHS performs around 150 000 arthroscopic knee operations a year, with more than half involving resection of the meniscus. Therefore, close scrutiny of this intervention in the United Kingdom is entirely appropriate, particularly in the context of the ongoing drive towards providing evidence based and value based care.  
bmj.com
over 5 years ago
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36

Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance

Pressure ulcers are serious and distressing, and they can affect people of any age. Not only do they increase mortality, result in extended hospital stays, and consume substantial healthcare resources, they are often an example of avoidable harm. Reported prevalence rates range from 4.7% to 32.1% in hospital populations and as much as 22% in nursing home populations.1 Prevention of this devastating condition must be a priority for the NHS. Stage 1 pressure ulcers (see box for definition of stages) can be reversible if identified promptly, and most stage 2 and 3 ulcers can be healed with appropriate care, but all require a multidisciplinary approach for effective management. It is hoped that this guideline will help reduce pressure ulcers nationally and improve care when pressure ulcers do occur.  
bmj.com
over 5 years ago
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1
21

Gallstones

Surgery is the only definitive treatment and is recommended for people with symptomatic gallstones who are fit to undergo surgery  
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over 5 years ago
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1
23

Second opinion reduces hysterectomies for uterine fibroids, study shows

Seeking a second opinion reduces the number of women undergoing a hysterectomy for symptomatic uterine fibroids, shows a study that indicates that multidisciplinary evaluation increases the use of less invasive treatments for this common condition.1  
bmj.com
over 5 years ago
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37

A man with a mass in the thigh

A 54 year old man presented to his general practitioner because of a fullness in his left lateral thigh that he first noticed while playing golf, although it was not related to an identifiable injury. He had a history of hypertension and fibromyalgia and was taking atenolol, ramipril, pregabalin, and tramadol but was otherwise well. The GP thought that the swelling was caused by a muscular injury, but the patient re-presented four months later because the mass had grown from a small bump to a swelling of 8 cm in diameter. It was also beginning to cause some knee stiffness but no pain. On examination he had a large firm swelling in his lateral thigh. On this occasion his GP referred him on a two week wait to the regional plastic surgery department. An ultrasound scan showed a 6 × 8 cm intramuscular mass with cystic changes and patchy neovascularity, but no inguinal or pelvic lymphadenopathy. Ultrasonography was followed by magnetic resonance imaging, with and without gadolinium contrast (fig 1⇓).  
bmj.com
over 5 years ago
Www.bmj
1
18

Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies

Objectives To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence and deaths.  
bmj.com
over 5 years ago
Static.www.bmj
1
37

Arthroscopy for degenerate meniscal tears of the knee

The NHS performs around 150 000 arthroscopic knee operations a year, with more than half involving resection of the meniscus. Therefore, close scrutiny of this intervention in the United Kingdom is entirely appropriate, particularly in the context of the ongoing drive towards providing evidence based and value based care.  
bmj.com
over 5 years ago
Www.bmj
1
28

Study finds that aspirin improves survival after colon cancer diagnosis

In a commentary an oncologist from New York said that enough evidence had now accumulated from observational studies to recommend aspirin to patients with new diagnoses of stage III colon cancer.2  
bmj.com
over 5 years ago
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1
11

Bladder cancer in women

A 76 year old woman reports recurrent urinary frequency, dysuria, and malodorous urine. No bacterial growth has been identified on two midstream urine samples, though empirical treatment with antibiotics has improved her symptoms. After three months, an episode of visible haematuria prompts referral and a transitional cell carcinoma of the bladder is diagnosed.  
bmj.com
over 5 years ago
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12

Gallstones

Surgery is the only definitive treatment and is recommended for people with symptomatic gallstones who are fit to undergo surgery  
bmj.com
over 5 years ago
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0
8

High caesarean section figures in Northern Ireland questioned - BBC News

Stormont's spending watchdog questions whether the high number of caesarean sections in Northern Ireland's hospitals is to save time rather than money.  
BBC News
over 5 years ago
Www.bmj
1
25

Management of women at high risk of breast cancer

The risk of breast cancer is multifactorial, but some women will have a high risk because of a genetic predisposition or, rarely, as a consequence of radiotherapy at a young age  
bmj.com
over 5 years ago
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1
5

Hartlepool patient almost had surgery on wrong body part - BBC News

Health chiefs "must re-establish public confidence" after a patient nearly underwent surgery on the wrong body part, a councillor says.  
BBC News
over 5 years ago
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1
17

Surgeons' leadership in the operating room: an observational study

Am J Surg. 2012 Sep;204(3):347-54. doi: 10.1016/j.amjsurg.2011.03.009. Epub 2011 Dec 16. Multicenter Study; Research Support, Non-U.S. Gov't  
ncbi.nlm.nih.gov
over 5 years ago
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1
14

Surgical leadership - Rothmund - 2013 - British Journal of Surgery - Wiley Online Library

*Correspondence to: Faculty of Medicine, Philipps University, Baldingerstrasse, Marburg 35033, Germany. E-mail: rothmund.dekan@staff.uni-marburg.de  
onlinelibrary.wiley.com
over 5 years ago
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1
11

Books

Atul Gawande, MD, MPH, is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital and is professor in both the Department of Health Policy and Management at the Harvard School of Public Health and the Department of Surgery at Harvard Medical School. He is Executive Director of Ariadne Labs, a joint center for health systems innovation, and Chairman of Lifebox, a nonprofit organization making surgery safer globally.  
atulgawande.com
over 5 years ago
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1
32

Painful diabetic neuropathy

Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly. These include the use of skin biopsies to measure small unmyelinated fibers, as well as even newer techniques that can measure both small unmyelinated fibers and large myelinated fibers in the same biopsy. The main treatments for painful diabetic neuropathy remain management of the underlying diabetes and drugs for the relief of pain. However, emerging evidence points to major differences between type 1 and type 2 diabetes, including the ability of glycemic control to prevent neuropathy. Enhanced glucose control is much more effective at preventing neuropathy in patients with type 1 diabetes than in those with type 2 disease. This dichotomy emphasizes the need to study the pathophysiologic differences between the two types of diabetes, because different treatments may be needed for each condition. The impact of the metabolic syndrome on neuropathy in patients with type 2 diabetes may account for the difference between the two types of diabetes and requires further study. Finally, neuropathic pain is under-recognized and undertreated despite an ever evolving list of effective drugs. Evidence exists to support several drugs, but the optimal sequence and combination of these drugs are still to be determined.  
www.bmj.com
over 5 years ago
Preview
1
22

Painful diabetic neuropathy

Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly. These include the use of skin biopsies to measure small unmyelinated fibers, as well as even newer techniques that can measure both small unmyelinated fibers and large myelinated fibers in the same biopsy. The main treatments for painful diabetic neuropathy remain management of the underlying diabetes and drugs for the relief of pain. However, emerging evidence points to major differences between type 1 and type 2 diabetes, including the ability of glycemic control to prevent neuropathy. Enhanced glucose control is much more effective at preventing neuropathy in patients with type 1 diabetes than in those with type 2 disease. This dichotomy emphasizes the need to study the pathophysiologic differences between the two types of diabetes, because different treatments may be needed for each condition. The impact of the metabolic syndrome on neuropathy in patients with type 2 diabetes may account for the difference between the two types of diabetes and requires further study. Finally, neuropathic pain is under-recognized and undertreated despite an ever evolving list of effective drugs. Evidence exists to support several drugs, but the optimal sequence and combination of these drugs are still to be determined.  
www.bmj.com
over 5 years ago