IntroductionHospitals are increasingly looking for mobile solutions to meet their information technology needs. Medical professionals are using personal mobile devices to support their work, because of limitations in both time and space. Our aims were to assess smartphone use amongst UK surgical doctors, the prevalence of medical app use and online activity.MethodsA thirteen-item questionnaire was derived to identify the proportion of surgical doctors of all grades using smartphones within the workplace. The following factors were evaluated: use of medical apps; use of online medical resources and if users were willing to use their own smartphone for clinical use.ResultsA total of 341 participants were surveyed with a complete response rate: 93.5% of which owned a smartphone, with 54.2% of those owning medical apps and 86.2% using their device to access online medical resources.Junior doctors were more likely to use medical apps over their senior colleagues (p = 0.001) as well as access the Internet on their smartphone for medical information (p < 0.001).Overall, 79.3% stated that they would be willing to use their smartphone for clinical use, which was found not to be dependent on seniority (p = 0.922).ConclusionOnline resources contribute significantly to clinical activities with the majority of smartphone users willing to use their own device. The information gathered from this study can aid developers to create software dedicated to the smartphone operating systems in greatest use and to potentially increase the use of a bring your own device (BYOD) scheme.

Perineal hernia formation was the commonest perineal complication of ELAPE and occurred in nearly half of patients having a laparoscopic ELAPE.

Schwannomas are peripheral nerve sheath tumours that can present as a rare tumour of GI tract, and even more uncommonly within the colon. We present a case of colonic schwannoma in an asymptomatic patient identified on surveillance colonoscopy. The tumour is of mesenchymal origin and is often challenging to diagnose prior to surgical resection. Endoscopy usually fails to provide adequate sample and diagnosis is usually confirmed on immunohistochemistry.

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Femoroacetabular Impingement (FAI) is characterized by abnormal contact of the hip joint. Many etiologies cause this painful condition, which leads to early osteoarthritis. While hip arthroscopy has become the most prevalent way to surgically correct a hip, some presentations of FAI require open surgical hip preservation techniques to fully address the pathology at hand. Certain head neck deformities may require open surgical hip dislocation utilizing a trochanteric slide osteotomy. A retroverted acetabulum may require an open periacetabular osteotomy to gain anteversion and eliminate impingement in the hip joint. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanter osteotomy. The sequelae of Legg-Calvé-Perthes disease causes complex abnormalities about the hip joint, which may require open surgery to address both the intra-articular pathology and the extra-articular pathology. Osteotomies of the proximal femur and acetabulum may all be necessary to restore a hip back to normal morphology. Chronic slipped capital femoral epiphysis (SCFE) may also require open surgical hip dislocations and complex intertrochanter osteotomies to recreate normal morphology.

Improving overall survival in recurrent glioblastoma remains a challenge, and drugs acting by unique mechanisms are urgently required. Ixazomib is an orally-administered proteasome inhibitor used in combination with lenalidomide and dexamethasone to treat patients with multiple myeloma who have received at least one prior therapy. However, ixazomib's ability to reach brain tumors has not been studied during its development. The aim of the present study (ClinicalTrials. gov, NCT02630030) was to establish and quantify ixazomib's presence in glioblastoma. The present study investigated 3 patients with recurrent glioblastoma after administration of oral ixazomib citrate (MLN 9708) at a fixed 4.0 mg dose within a 3-hpreoperative window. A total of 2 blood samples were taken from each patient at the time of incision, tumor sampling and closure. Brain tumor samples were collected during tumor resection. These samples were then used to measure the plasma and brain tumor tissue concentration of the biologically-active form of ixazomib (MLN 2238). Patient 1 had plasma concentrations of ixazomib averaging 26.2, 21.8 and 15.3 ng/ml at incision, tumor sampling and closure, respectively. The brain tumor tissue concentration was 7.88 ng/g. Patient 2 had the same interval and brain tumor tissue measurements of 19.0, 18.0 and 8.93 ng/ml, and 2.03 ng/g. Patient 3 had plasma concentration interval measurements of 25.6, 36.2 and 28.7 ng/ml. Multiple brain tumor tissue samples were taken in patient 3, with an average tissue ixazomib concentration of 3.37 ng/g. Ixazomib was found at plasma concentrations commensurate with its previously established pharmacokinetic profile without clinically relevant drug-related adverse events. Ixazomib reaches glioblastoma tissues at measurable concentrations at the time of tumor resection, confirming target tissue delivery. This justifies the phase I study of ixazomib in recurrent glioblastoma currently in development.

Over half of the referrals did not meet the NICE criteria, suggesting that the system is being used as a rapid access route to investigation. Despite this, there is no significant difference in the pickup rate of colorectal cancer in patients with or without high-risk features. Nurse-led 2WW clinics with subsequent investigation appear to be effective in both the identification and exclusion of colorectal cancer.

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