Aim Bowel preservation is paramount in Crohn's disease surgery as affected patients are typically young adults at risk of having several abdominal surgical procedures during their lifetime. Intra‐operative assessment of the extent and location of Crohn's disease is not standardized and is left to a mixture of the surgeon's experience, tactile feedback, macroscopic appearance and preoperative imaging. The aim of this study was to describe the technical steps of a standardized protocol for intra‐operative ultrasound assessment of the small bowel in patients undergoing surgery for ileocolic Crohn's disease. Method After laparoscopic mobilization of the bowel, a periumbilical incision is performed for extracorporeal division of the mesentery and the resection and anastomosis. A gastrointestinal consultant radiologist, with expertise in Crohn's disease imaging and abdominal ultrasound, performs full intra‐operative assessment of the small bowel by applying a sterile ultrasound probe directly to the bowel, prior to resection being performed by the surgeon. The bowel is assessed through the wound protector with a sterile technique and the length, location and number of segments is documented together with further quantitative assessment using the METRIC (MR enterography or ultrasound in Crohn's disease) scoring guide. Results A step‐by‐step protocol for intra‐operative ultrasound evaluation of the entire small bowel is described. Conclusions A standardized approach to intra‐operative evaluation of the extent and location of Crohn's disease is desirable. Intra‐operative ultrasound may provide added value for assessment of proximal and multifocal Crohn's disease.
Introduction: Role extension into novel areas of ultrasound practice can be challenging for health care professionals. Expansion into existing areas of advanced practice typically occurs using established processes and accredited training; however, in areas where there is no formal training, there can be a lack of support for how to develop new and progressive clinical roles. Topic Description: This article presents how the use of a framework approach for establishing areas of advanced practice can support individuals and departments with safely and successfully developing new roles in ultrasound. The authors illustrate this via the example of a gastrointestinal ultrasound role, developed in an NHS department. Discussion: The framework approach comprises three elements, each interdependent upon and inform each other: (A) Scope of practice, (B) Education and competency and (C) Governance. (A) Defines (and communicates) the role extension and area(s) of subsequent ultrasound imaging, interpretation and reporting. By identifying the why, how and what is required this informs (B) the education and assessment of competency for those taking on new roles or areas of expertise. (C) Is informed by (A) and is an ongoing process of quality assurance to safeguard high standards in clinical care. In supporting role extension, this approach can facilitate new workforce configurations, skill expansion and enable increasing service demands to be met. Summary: By defining and aligning the components of scope of practice, education/competency and governance, role development in ultrasound can be initiated and sustained. Role extension utilising this approach brings benefits for patients, clinicians and departments.
Amoebic infection in two male homosexuals is described. The possibility that this infection was acquired through homosexual practices and the implications to clinical and diagnostic services is discussed. Amoebiasis is an uncommon disease in Britain. An estimated 200 new cases of amoebiasis occur annually in England and Wales.1 The disease may be fatal if misdiagnosed or inappropriately treated.2 Most infections are acquired in an endemic area, although occasionally infection has been reported in persons who have never been abroad.3 More recently, several reports from the United States, and from New York in particular, have suggested that protozoal bowel infections including E. histolytica are common among the sexually active homosexual population.4-8 We report two cases of amoebic infection occurring in homosexual males which were probably sexually acquired in England.
Background Intraoperative assessment of the extent and location of Crohn's disease is not standardised and relies on a mixture of surgeons' experience, tactile feedback and macroscopic appearance. To overcome this variability, we developed a protocol for full intraoperative ultrasound scan of the small bowel and we here report the results of "Assessing the Feasibility and Safety of Using Intraoperative Ultrasound in Ileocolic Crohn's Disease-The IUSS CROHN Study". Methods This is a prospective single centre observational study with enrolment of all patients undergoing elective surgery for terminal ileal Crohn's disease from January 2019 to March 2020. Patients underwent laparoscopic ileocolic resection, according to a standardised technique. Ultrasound intraoperative quantitative assessment was performed according to the METRIC (MREnterography or ulTRasound in Crohn's disease) scoring guide. Results Intraoperative ultrasound was successfully performed in 6 patients from the ileocaecal valve to the proximal jejunum. The median time required was 23.5 min (range 17-37 min) as compared to 6.5 min (5-12 min) required for the macroscopic evaluation performed by the surgeon. In 3 patients, intraoperative ultrasound identified more disease than surgical evaluation. Conclusions This feasibility study demonstrated the safety of intraoperative ultrasound and allowed the development of a standardised protocol for intraoperative ultrasound and the data collection required to inform a randomised multicentre study.
previous vogue for inserting a pelvic prosthesis which could prove imperfect and needs removal once therapy has been concluded [3,4]. Pelvic mesh placement is familiar to surgeons whose practice includes surgery for rectal prolapse. Whilst alternative methods of mesh fixation are used, many prefer the careful placement of sutures as gold standard. Precise suturing, however, can be tricky especially for those with lower volume experience in this task. This technical concern has led some to propose robotic assistance [5] although this adds considerable expense and some additional complexity, as well as being limited in availability. The FlexDex system (FlexDex Surgical, Brighton, Michigan, USA) is a solely mechanical articulating device that converts a surgeon's hand, wrist and arm movements into corresponding movements of the instrument's end-effector inside the patient [6]. It is a single use device that, with some prior training [7], enables ergonomic and accurate suturing via standard laparoscopic ports and without the need for any additional equipment. In the associated video (Video S1) we show the concept and practice of this device in assisting the correct placement of a mesh in a patient with prostatic cancer prior to therapeutic radiation. The patient made an uneventful recovery, and was able to be discharged on the first postoperative day and proceeded to radiotherapy 2 weeks later.
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Introduction Journal clubs have evolved over recent years within healthcare to encourage continuing professional development. More recently, there has been a move from face-to-face group meetings to virtual groups utilising social media platforms. This article aims to explore the discussions and narrative following the inaugural BMUS journal club, highlighting the key discussions and themes from the participants and to provide a narrative for the future of ultrasound continuing professional development. Methods The August 2020 journal club chat was focussed on the article featured in Ultrasound: “Sonographers’ level of autonomy in communication in Australian obstetric settings: Does it affect their professional identity?” by Thomas et al. Data consisting of Twitter correspondence were extracted and analysed from the advanced search function on Twitter using #BMUS_JC thread. An initial review ensured related content was included. A second review and semantic thematic analysis was then conducted on the 123 tweets. Results In total, seven overall themes were identified between the three sub-threads within the journal club discussions. Those participating in the Twitter discussion recognised the limitations and barriers for communicating results to patients, acknowledging that training, support and regulatory involvement is required for sonographers to change practice locally and internationally. Conclusion The group discussions on Twitter highlight the ongoing issues for sonographers’ professional identity worldwide. Furthermore, our analysis echo other contemporary studies which indicate that Twitter journal clubs act as a fruitful and dynamic source of continuing professional development, particularly in an era where social distancing is encouraged. The outcomes of the first BMUS journal club support the wider evidence that online journal clubs can provide a successful platform for professional discussion and debate.
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