Penile Trauma Burden and Aetiology in the Paediatric and Adult Population: A Scoping Review and Critical Analysis of the Literature.

Penile trauma is rare. It is associated with the impairment of physiological functions and deterioration in patients' quality of life. Currently, the relevance of age demographics in the occurrence of this debilitating injury has not been well discussed. The objective of this study was to provide a scoping review of penile trauma within the lens of the legal age of maturity. A search of the PubMed, Scopus and Web of Science databases was conducted, and then, the identified publications were used to conduct this scoping review focussing on the study aim. The results identified were categorised into five themes. This included publication information (author, year, country, study duration); demographic information (age of presentation, number of patients, relative burden); penile trauma clinical pattern (type, severity, associated injury), risk factors and clinical consequences. While mobile and active young adults were at risk of outdoor trauma, the report on penile trauma in the paediatric population is rare and usually focussed on sexual trauma. Penetrating trauma has been more extensively studied in comparison to blunt penile trauma despite the significance of the latter in the paediatric population. Injury severity classification is not available for most studies limiting their usefulness in the universal comparison of trauma severity and injury prognostication. There is a diversity in the burden and presentation of penile trauma. Available research studies are limited in the paediatric population, mostly focussed on penile fracture in adults and generally devoid of a standardised penile trauma severity description. Additional studies with a specific focus on penile trauma are required to characterise aetiological risks and injury severity across the legal age of maturity.

Interrater reliability of the Clinical Frailty Scale in the anesthesia preadmission clinic.

PURPOSE: As many as 30% of patients with frailty die, are discharged to a nursing home, or have a new disability after surgery. The 2010 United Kingdom National Confidential Enquiry into Patient Outcome and Death recommended that frailty assessment be developed and included in the routine risk assessment of older surgical patients. The Clinical Frailty Scale (CFS) is a simple, clinically-assessed frailty measure; however, few studies have investigated interrater reliability of the CFS in the surgical setting. The objective of this study was to determine the interrater reliability of frailty classification between anesthesiologists and perioperative nurses. METHODS: We conducted a cohort study assessing interrater reliability of the CFS between perioperative nurses and anesthesiologists for elective surgical patients aged ≥ 65 yr, admitted to a large regional university-affiliated hospital in Australia between July 2020 and February 2021. Agreement was measured via Cohen's kappa. RESULTS: Frailty assessment was conducted on 238 patients with a median [interquartile range] age of 74 [70-80] yr. Agreement was perfect between nursing and medical staff for CFS scores in 112 (47%) patients, with a further 99 (42%) differing by only one point. Interrater kappa was 0.70 (95% confidence interval, 0.63 to 0.77; P < 0.001), suggesting good agreement between anesthesiologists and perioperative nurses. CONCLUSION: This study suggests that CFS assessment by either anesthesiologists or nursing staff is reliable across a population of patients from a range of surgical specialities, with an acceptable degree of agreement. The CFS measurement should be included in the normal preanesthesia clinic workflow.

RéSUMé: OBJECTIF: Jusqu'à 30 % de la patientèle fragilisée meurt, est envoyée dans un centre d'hébergement et de soins de longue durée, ou souffre d'une nouvelle invalidité après la chirurgie. L'enquête nationale confidentielle de 2010 du Royaume-Uni sur les Devenirs et les décès des patient·es (National Confidential Enquiry into Patient Outcome and Death) a recommandé que l'évaluation de la fragilité soit élaborée et incluse dans l'évaluation systématique du risque pour la patientèle chirurgicale âgée. L'échelle de fragilité clinique (EFC) est une mesure de la fragilité simple et évaluée cliniquement; cependant, peu d'études ont examiné la fiabilité interévaluateur·trice de cette échelle en milieu chirurgical. L'objectif de cette étude était de déterminer la fiabilité interévaluateur·trice de la classification de la fragilité entre les anesthésiologistes et le personnel infirmier périopératoire. MéTHODE: Nous avons mené une étude de cohorte évaluant la fiabilité interévaluateur·trice de l'EFC entre le personnel infirmier périopératoire et les anesthésiologistes pour la patientèle de chirurgie non urgente âgée de ≥ 65 ans et admise dans un grand hôpital universitaire régional affilié en Australie entre juillet 2020 et février 2021. La concordance a été mesurée via le coefficient Kappa de Cohen. RéSULTATS: Une évaluation de la fragilité a été réalisée pour 238 patient·es dont l'âge médian [écart interquartile] était de 74 ans [70-80]. La concordance dans les scores sur l'EFC était parfaite entre le personnel infirmier et médical pour 112 (47 %) patient·es, et ne différait que d'un point chez 99 autres (42 %) personnes. Le coefficient Kappa était de 0,70 (intervalle de confiance à 95 %, 0,63 à 0,77; P < 0,001), suggérant une bonne concordance entre les anesthésiologistes et le personnel infirmier périopératoire. CONCLUSION: Cette étude suggère que l'évaluation via l'EFC par des anesthésiologistes ou du personnel infirmier est fiable pour une population de patient·es pris·es en charge par diverses spécialités chirurgicales, avec un degré acceptable de concordance. Cette échelle de mesure devrait être incluse dans le flux de travail normal de la clinique de préanesthésie.

Surgical safety checklists in UK veterinary practice: Current implementation and attitudes towards their use.

BACKGROUND: Surgical safety checklist (SSC) use benefits veterinary patients, but endorsement and implementation are essential for these benefits to be observed. METHODS: A cross-sectional survey assessed UK veterinary professionals' attitudes towards and usage of SSCs and identified factors associated with poorer attitude or failure to use SSCs. RESULTS: Of 513 respondents, 70% used SSCs. Of these, 87.1% used SSCs for every surgical procedure, 19.1% adapted SSCs for different procedures and 61.1% had a standard operating procedure detailing how to use SSCs. Attitudes towards SSC use were favourable, with increased positive attitude associated with employing at least one registered veterinary nurse with a post-qualifying qualification (p < 0.001), current SSC use (p < 0.001), undertaking self-directed reading (p = 0.033) or completing SSC-relevant post-qualification continuing professional development (p = 0.005). Factors associated with veterinary practices not using SSCs included Practice Standards Scheme (PSS) non-membership (odds ratio [OR] 2.0, 1.1-3.4), no RCVS hospital status (OR 1.9, 1.1-3.5) or being a mixed first-opinion veterinary practice (OR 2.4, 1.2-5.0). LIMITATIONS: Study limitations include sampling methodology and non-validated attitudinal scale usage. CONCLUSION: Most respondents used SSCs. Familiarity, education and the RCVS PSS were associated with improved uptake and attitudes, but mixed practice was associated with reduced usage.

Lead pulling as a welfare concern in pet dogs: What can veterinary professionals learn from current research?

Veterinary professionals (VPs) are often the first source of advice for clients struggling with their dog's behaviour, and pulling on the lead is a commonplace undesirable behaviour VPs will encounter regularly in practice. Excluding bites, being pulled over while walking on a lead is the leading cause of non-fatal dog-related injuries in the UK. This narrative review investigates lead pulling as a welfare concern in pet dogs, highlighting aspects of the literature of particular interest to VPs. Lead pulling could negatively affect walk quality, frequency and duration, causing weight gain, while decreased environmental enrichment could trigger other undesirable behaviours. Aversive equipment to prevent lead pulling can cause pain, distress and injury, but even equipment considered humane can have welfare consequences. Punitive training methods could cause dogs stress, fear and anxiety and trigger aggressive behaviour. While these lead pulling outcomes are welfare concerns in themselves, they could also weaken dog-owner attachment, a risk factor in pet dog relinquishment. Given lead pulling could affect the welfare of patients in a VPs care, clinical implications and opportunities for client education are outlined. Educating clients on humane prevention and modification of lead pulling could make walks easier, safer and more enjoyable, with positive outcomes for clients, canine welfare and the practice.

Critically Appraised Topics (CATs) in Veterinary Medicine: Applying Evidence in Clinical Practice.

Critically appraised topics (CATs) are evidence syntheses that provide veterinary professionals with information to rapidly address clinical questions and support the practice of evidence-based veterinary medicine (EBVM). They also have an important role to play in both undergraduate and post-registration education of veterinary professionals, in research and knowledge gap identification, literature scoping, preparing research grants and informing policy. CATs are not without limitations, the primary one relating to the rapid approach used which may lead to selection bias or restrict information identified or retrieved. Furthermore, the narrow focus of CATs may limit applicability of the evidence findings beyond a specific clinical scenario, and infrequently updated CATs may become redundant. Despite these limitations, CATs are fundamental to EBVM in the veterinary profession. Using the example of a dog with osteoarthritis, the five steps involved in creating and applying a CAT to clinical practice are outlined, with an emphasis on clinical relevance and practicalities. Finally, potential future developments for CATs and their role in EBVM, and the education of veterinary professionals are discussed. This review is focused on critically appraised topics (CATs) as a form of evidence synthesis in veterinary medicine. It aims to be a primary guide for veterinarians, from students to clinicians, and for veterinary nurses and technicians (hereafter collectively called veterinary professionals). Additionally, this review provides further information for those with some experience of CATs who would like to better understand the historic context and process, including further detail on more advanced concepts. This more detailed information will appear in pop-out boxes with a double-lined surround to distinguish it from the information core to producing and interpreting CATs, and from the boxes with a single line surround which contain additional resources relevant to the different parts of the review.

Minimally invasive surgical management of spontaneous esophageal perforation (Boerhaave's syndrome).

BACKGROUND: Spontaneous esophageal perforation (Boerhaave's syndrome) is a highly morbid condition traditionally associated with poor outcomes. The Pittsburgh perforation severity score (PSS) accurately predicts risk of morbidity, length of stay (LOS) and mortality. Operative management is indicated among patients with medium (3-5) or high (> 5) PSS; however, the role of minimally invasive surgery remains uncertain. METHODS: Consecutive patients presenting with Boerhaave's syndrome with intermediate or high PSS managed via a thoracoscopic and laparoscopic approach from 2012 to 2018 were reviewed. Demographics, clinical presentation, management, and outcomes were analyzed. RESULTS: Ten patients (80% male) with a mean age of 61.3 years (range 37-81) were included. Two patients had intermediate and eight had high PSS (7.9 ± 2.8, range 4-12). The mean time from onset of symptoms to diagnosis was 27 ± 12 h and APACHE II score was 13.6 ± 4.9. Thoracoscopic debridement and primary repair was performed in eight cases, with two perforations repaired primarily over a T-tube. Laparoscopic feeding jejunostomy was performed in all patients. Critical care LOS was 8.7 ± 6.8 days (range 3-26), while inpatient LOS was 23.1 ± 12.5 days (range 14-46). Mean comprehensive complications index was 42.1 ± 26.2, with grade IIIa and IV morbidity in 60% and 10%, respectively. One patient developed dehiscence at the primary repair, which was managed non-operatively. In-hospital and 90-day mortality was 10%. CONCLUSION: Minimally invasive surgical management of spontaneous esophageal perforation with medium to high perforation severity scores is feasible and safe, with outcomes which compare favorably to the published literature.