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Korambayil SM, Iyer S, Moran A, Beaton C. Are we overtreating patients with malignant colorectal polyps? A 5-year review of the ACPGBI position statement. Ann R Coll Surg Engl 2022; 104:125-129. [PMID: 34730439 PMCID: PMC9773858 DOI: 10.1308/rcsann.2021.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 2013, The Association of Coloproctology of Great Britain and Ireland (ACPGBI) issued a position statement regarding management of malignant polyps. We reviewed the management of endoscopically resected malignant colorectal polyps in a district general hospital to evaluate whether patients were being overtreated as per these guidelines. METHODS All patients who underwent a complete, non-piecemeal endoscopic removal of a malignant polyp between October 2013 and September 2018 were studied. Polyps were risk stratified for residual disease and followed up as per the ACPGBI. Patients were divided into two groups based on management after polypectomy. Primary outcome measured was the presence of residual tumour or involved lymph nodes in the resection specimen. Secondary outcomes included complications and recurrence. RESULTS Thirty-three patients were included: 21 in the non-operative group (NOG) and 12 in the operative group (OG). The ACPGBI risk score in the NOG varied between 1 and over 4 compared with the OG who all scored over 4. Two patients in the OG (16%) demonstrated residual disease. Five patients suffered a postoperative complication. No recurrences were noted in the OG and one in the NOG. CONCLUSION Our findings against a backdrop of the available literature suggest that the risk of residual disease after malignant polypectomy may not be as high as stated by the ACPGBI. As a result, there is a risk of overtreating patients and exposing them to the significant complications of surgery if careful consideration is not exercised.
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Affiliation(s)
| | - S Iyer
- Northern Devon Healthcare NHS Trust, UK
| | - A Moran
- Northern Devon Healthcare NHS Trust, UK
| | - C Beaton
- Northern Devon Healthcare NHS Trust, UK
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Hubbard T, Beaton C. Using nylon tape to aid the formation of loop stomas. Ann R Coll Surg Engl 2017; 100:346-347. [PMID: 29022821 DOI: 10.1308/rcsann.2017.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- T Hubbard
- North Devon District Hospital , Barnstaple , UK
| | - C Beaton
- North Devon District Hospital , Barnstaple , UK
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Frank L, Ide K, Beaton C. Using CR-POSSUM to plan HDU admissions for high-risk patients undergoing colonic resections. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Beaton C, Stephenson BM, Williams GL. Risk of lymph node metastasis in malignant colorectal polyps. Colorectal Dis 2014; 16:67. [PMID: 24034585 DOI: 10.1111/codi.12404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 08/17/2013] [Indexed: 02/08/2023]
Affiliation(s)
- C Beaton
- North Devon District Hospital, Barnstaple, UK; Royal Gwent Hospital, Newport, UK.
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Beaton C, Twine CP, Williams GL, Radcliffe AG. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis 2013; 15:788-97. [PMID: 23331927 DOI: 10.1111/codi.12129] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/04/2012] [Indexed: 12/13/2022]
Abstract
AIM Lymph node (LN) metastases are present in up to 17% of early colorectal cancers (pT1). Identification of associated histopathological factors would enable counselling of patients regarding this risk. METHOD Pubmed and Embase were employed utilizing the terms 'early colorectal cancer', 'lymph node metastasis', 'submucosal invasion', 'lymphovascular invasion', 'tumour budding' and 'histological differentiation'. Analysis was performed using REVIEW MANAGER 5.1. RESULTS Twenty-three cohort studies including 4510 patients were analysed. There was a significantly higher risk of LN metastasis with a depth of submucosal invasion > 1 mm than with lesser degrees of penetration (OR 3.87, 95% CI 1.50-10.00, P = 0.005). Lymphovascular invasion was significantly associated with LN metastasis (OR 4.81, 95% CI 3.14-7.37, P < 0.00001). Poorly differentiated tumours had a higher risk of LN metastasis compared with well or moderately differentiated tumours (OR 5.60, 95% CI 2.90-10.82, P < 0.00001). Tumour budding was found to be significantly associated with LN metastasis (OR 7.74, 95% CI 4.47-13.39, P < 0.001). CONCLUSION Meta-analysis of the current literature demonstrates that in early colorectal cancer a depth of submucosal invasion by the primary tumour of > 1 mm, lymphovascular invasion, poor differentiation and tumour budding are significantly associated with LN metastasis.
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Affiliation(s)
- C Beaton
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, UK.
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Williams GL, Beaton C, Codd R, Stephenson BM. Avoiding extraction site herniation after laparoscopic right colectomy. Tech Coloproctol 2012; 16:385-8. [DOI: 10.1007/s10151-012-0830-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/14/2012] [Indexed: 01/10/2023]
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Mortimer MCM, Beaton C, Swarnkar KJ. Postoperative perforation secondary to retained endocapsule. Colorectal Dis 2011; 13:e318-9. [PMID: 21689296 DOI: 10.1111/j.1463-1318.2011.02603.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M C M Mortimer
- Department of General Surgery, Royal Gwent Hospital, Stow Hill, Newport, Gwent, UK
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Evans MD, Thomas C, Beaton C, Williams GL, McKain ES, Stephenson BM. Lowering the incidence of stomal herniation: further follow up of the lateral rectus abdominis positioned stoma. Colorectal Dis 2011; 13:716-7. [PMID: 21564473 DOI: 10.1111/j.1463-1318.2011.02635.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Thomas C, Beaton C, Williams GL, McKain ES, Stephenson BM. Recto-vesical fistulation complicating a faecal incontinence management product in Clostridium difficile diarrhoea. Colorectal Dis 2011; 13:e90-1. [PMID: 21054743 DOI: 10.1111/j.1463-1318.2010.02484.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- C Thomas
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, South Wales, UK
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Abstract
Worldwide internet access is increasing exponentially. The UK Government Office for National Statistics reported that between 2002 and 2009 the proportion of UK households with internet access increased from 46% to 70%. Between 2007 and 2009 the proportion of UK adults using the internet to access health information rose from 27% to 42%. Similar situations exist in Continental Europe and the USA, where 52% of internet users and 61% of adults respectively search online for medical information. In 2003 it was estimated that 4.5% of all internet searches globally were for health related information. Moreover, patients now frequently choose to seek health information online. Indeed Hesse et al reported that almost one in two patients search the internet before consulting a physician.
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Affiliation(s)
- TD Reid
- Specialist Registrar in General Surgery, University Hospital of Wales, Cardiff
| | - C Beaton
- Specialist Registrar in General Surgery, University Hospital of Wales, Cardiff
| | - IL Davies
- Clinical Research Fellow in General Surgery, University Hospital of Wales, Cardiff
| | - D Arnold
- Medical Student, University Hospital of Wales, Cardiff
| | - JBM Ward
- Medical Student, University Hospital of Wales, Cardiff
| | - WG Lewis
- Consultant Surgeon, University Hospital of Wales, Cardiff
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Beaton C, Cochlin D, Kumar N. Contrast enhanced ultrasound should be the initial radiological investigation to characterise focal liver lesions. Eur J Surg Oncol 2009; 36:43-6. [PMID: 19709846 DOI: 10.1016/j.ejso.2009.07.187] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 07/26/2009] [Accepted: 07/30/2009] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Contrast enhanced ultrasound (CEUS) involves the administration of a microbubble contrast agent followed by a US scan to evaluate the liver lesion through all phases of enhancement. Although technical difficulty and operator dependence can be encountered, CEUS is thought to be superior to conventional US and CT. This study aims to determine how effective CEUS is at characterising focal liver lesions and to establish its role in the diagnostic algorithm. METHODS All patients who underwent a liver CEUS performed by a single consultant radiologist were identified over a 5 year period. The CEUS report, CT, MRI and/or PET report, histopathology report and case notes were reviewed. RESULTS 127 patients were included. CEUS correctly identified 71 of 77 malignant lesions and all of the benign liver lesions. The sensitivity of CEUS for detecting and correctly characterising a malignant FLL is therefore 92% with a specificity of 100%. CONCLUSION Our study shows that CEUS has a high sensitivity and specificity for characterising focal liver lesions. CEUS has advantages over CT and MRI of a high degree of safety, good patient tolerance and often availability at the time of initial detection. We therefore suggest that CEUS should be used as the initial study in the characterisation of FLLs. The study should be followed, as appropriate, by CT and MRI or PET studies. Biopsy, with its risks of tumour seeding and false negative results should only be considered after review of the imaging studies and full MDT discussion.
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Affiliation(s)
- C Beaton
- Department of Surgery, University Hospital Wales, Heath Park, Cardiff CF14 4XW, UK
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Stewart CJR, Baker E, Beaton C, Crook M, Peverall J, Wallace S. Detection of Y-chromosome in gonadal tumours using fluorescence in situ hybridization: diagnostic value in intersex conditions including older patients with clinically unsuspected androgen insensitivity syndrome. Histopathology 2007; 52:175-82. [DOI: 10.1111/j.1365-2559.2007.02927.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Beaton C, Morgan MA, Shute K, Hopper AN, Stephens MR, Lewis WG. Influence of targeted basic surgical training lists on SHO operative experience in the EWTD era. ACTA ACUST UNITED AC 2007. [DOI: 10.1308/147363507x206420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Presented at the Association of Surgeons of Great Britain and Ireland, Edinburgh, May 2006.
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Affiliation(s)
- C Beaton
- Departments of Surgery, Royal Gwent Hospital, Newport and the University Hospital of Wales, Cardiff
| | - MA Morgan
- Departments of Surgery, Royal Gwent Hospital, Newport and the University Hospital of Wales, Cardiff
| | - K Shute
- Departments of Surgery, Royal Gwent Hospital, Newport and the University Hospital of Wales, Cardiff
| | - AN Hopper
- Departments of Surgery, Royal Gwent Hospital, Newport and the University Hospital of Wales, Cardiff
| | - MR Stephens
- Departments of Surgery, Royal Gwent Hospital, Newport and the University Hospital of Wales, Cardiff
| | - WG Lewis
- Departments of Surgery, Royal Gwent Hospital, Newport and the University Hospital of Wales, Cardiff
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Abstract
The European Working Time Directive (EWTD) will reduce the clinical experience obtained by surgeons prior to attaining consultant status from 21,000 surgical hours to 7,640 hours, 1 with shift work obligatory for compliance. We have shown previously that the operative experience of SHOs in general surgery is on the wane in our own hospital, varies with subspecialty interest 2 and has witnessed further erosion by the introduction of the EWTD. 3 The aim of this study was to assess the influence of an all tier shift rota on the emergency and elective operative experience of SHOs in a category 1 general surgical training post working in a large district general hospital serving a population of 600,000.
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Affiliation(s)
- C Beaton
- Department of Surgery, Royal Gwent Hospital, Newport
| | - MR Stephens
- Department of Surgery, Royal Gwent Hospital, Newport
| | - AN Hopper
- Department of Surgery, Royal Gwent Hospital, Newport
| | - WG Lewis
- Department of Surgery, Royal Gwent Hospital, Newport
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Abstract
The European Working Time Directive (EWTD) represents the latest challenge to surgical training in the UK, following Calmanisation and the implementation of the New Deal on junior doctors' hours. Compliance with the EWTD in the UK demands shift working patterns and as such it has received a mixed response from the UK medical profession. While physicians in training are relatively content with the regulations of the EWTD, surgical trainees have voiced concerns regarding the potential impact of an altered working week on their clinical experience and training as well as quality of life.
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Affiliation(s)
| | | | - AN Hopper
- University Hospital of Wales, Cardiff
| | | | - WG Lewis
- University Hospital of Wales, Cardiff
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Cox PD, Beaton C, Bossers A, Pepper J, Gage M. Interdisciplinary pilot project in a rehabilitation setting. J Allied Health 1999; 28:25-9. [PMID: 10189608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This project qualitatively evaluated the planning, implementation, and outcome of an interdisciplinary model of clinical education. Expectations of physiotherapy (PT), occupational therapy (OT), and speech-language pathology (SLP) students and clinicians were assessed to determine whether the model allowed for the acquisition of the interdisciplinary knowledge and skills needed for current practice. Students from OT (n = 5), PT (n = 3), and SLP (n = 1) undertook normally scheduled five-to-eight-week clinical placements, beginning on the same start date. All students were at intermediate or senior levels in their programs. Discipline-specific activities were supervised by clinical instructors from the disciplines. Interdisciplinary sessions during the first five weeks covered cross-disciplinary activities related to clinical reasoning, interviewing techniques, professionalism, and communication skills for team reporting. Themes related to the clinical experience were derived from student and supervisor responses to pre-and post-placement questionnaires, post-placement focus group interviews, and student journals. The response to the model was positive. The students felt they had gained insights into developing interdisciplinary skills, although they did feel that some discipline-specific needs were not met. The instructors were less enthusiastic but, given better planning and communication before the placement, welcomed the opportunity to try it again.
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Affiliation(s)
- P D Cox
- Elborn College, University of Western Ontario, London, Canada.
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Gibson MC, Bol N, Woodbury MG, Beaton C, Janke C. Comparison of caregivers', residents', and community-dwelling spouses' opinions about expressing sexuality in an institutional setting. J Gerontol Nurs 1999; 25:30-9. [PMID: 10426032 DOI: 10.3928/0098-9134-19990401-07] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Opinions regarding the appropriateness of elderly residents' sexual behaviors in a chronic care hospital and how to respond to inappropriate behaviors were surveyed. Study participation was open to all staff (N = 1,205), eligible residents (N = 182) and community-dwelling spouses (N = 103). Participation rates were 40% (residents), 42% (spouses), 34% (nursing staff), 50% (allied health staff), and 22% (support staff). Staff completed the questionnaire independently, while residents and spouses were offered self-completion or a structured interview. Almost all selected the interview. Residents and spouses were less tolerant than staff of residents' masturbating, engaging in sexual relationships, viewing sexual materials, and making sexual approaches to staff. Privacy was the primary determinant of appropriateness for behaviors for all groups. Staff and spouses were more likely to endorse counseling when behaviors were perceived as inappropriate than residents. Nurses endorsed counseling less frequently than allied health professionals and support staff. Nurses were more likely to have been approached sexually by a resident. Differences of opinion are interpreted in terms of cohort influences on values and contextual influences on behavior.
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Affiliation(s)
- M C Gibson
- Veterans Care Program, Parkwood Hospital, London, Ontario, Canada
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Abstract
BACKGROUND Midazolam sedation has been shown to diminish recall of one to four cards shown prior to induction of general anesthesia in pediatric patients. This promising but limited finding prompted us to investigate the effect of midazolam sedation on retrograde and anterograde recall and recognition in children scheduled for elective surgery. METHODS Forty patients aged 4-10 yr were randomized using a double-blind study design to receive either 0.2 mg/kg intranasal midazolam or 0.2 ml/5 kg placebo (distilled water) using a Devilbiss #286 atomizer. To assess postoperative memory of preoperative events, recall and recognition tasks were performed using a series of picture cards designed for this purpose. Retrograde amnesia was measured by postoperative recall and recognition of cards shown prior to midazolam/placebo administration, and anterograde amnesia was measured by postoperative recall and recognition of cards shown during the interval between midazolam/placebo administration and induction of general anesthesia. RESULTS Compared to placebo, the midazolam group experienced a significant postoperative reduction in ability to both recall (P < .003) and recognize (P < .001) cards shown subsequent to midazolam/placebo administration (anterograde amnesia). In distinction, there was no difference between groups in postoperative ability to recall or recognize cards shown prior to midazolam/placebo administration (retrograde amnesia). CONCLUSIONS These results support and extend the inference that midazolam diminishes anterograde recall. In addition, our findings indicate that midazolam diminishes anterograde recognition, thereby providing partial anterograde amnesia without affecting retrograde memory in pediatric patients.
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Affiliation(s)
- R S Twersky
- Long Island College Hospital, Ambulatory Surgical Unit, Brooklyn, New York
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