The SCARE Statement: Consensus-based surgical case report guidelines

AbstractIntroductionCase reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.MethodsThe CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.ResultsIn round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.ConclusionWe present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports

The SCARE Statement: Consensus-based surgical case report guidelines

Introduction: Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.Methods: The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group.Results: In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7–9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist.Conclusion: We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports.</p

A clinical evaluation of remote ischaemic preconditioning for organ protection

Periprocedural complications are an issue for patients with cardiovascular disease. Remote ischaemic preconditioning (RIPC) may offer periprocedural organ protection. Although the proof of concept data underpinning RIPC are encouraging, there are few data regarding clinical endpoints. The first component of this thesis comprises a literature review that explores the history and current status of RIPC with a focus on cardiovascular interventions. This is followed by two systematic reviews and meta-analyses. The first review examined the role of RIPC in percutaneous coronary intervention (PCI) and found a significant reduction in periprocedural myocardial infarction (MI) rates with RIPC, although the number of included patients was small. The second review examined the role of RIPC in the prevention of major clinical complications following cardiovascular surgery and found no significant effect although MI rates were reduced almost by half with RIPC. Heterogeneity of the studies and small individual sample sizes were likely to have rendered the meta-analysis underpowered. The remainder of the thesis comprises two pilot clinical trials. The first examined RIPC as a renoprotective strategy following contrast-enhanced computed tomography scanning. It demonstrated feasibility and it found that RIPC may have reduced kidney injury in those with impaired renal function but it found no evidence for a benefit across the whole cohort. The second trial examined RIPC in the setting of major vascular surgery in three centres. It found no significant effect on clinical outcomes or on troponin leakage following surgery although it demonstrated feasibility. The meta-analyses generated new data on the pooled effects of RIPC, thereby encouraging further clinical studies. The trials demonstrated feasibility and yielded data to guide future studies. RIPC represents an attractive and cheap risk reduction tool. If convincing data on patient important outcomes can be generated, it will become widespread

Adult intussusception caused by myoepithelial hamartoma in the small bowel: A case report

Introduction: Intussusception is rare in adults and can have acute, intermittent or chronic presentations. We present an unusual case of intussusception in an adult. Presentation of case: A 25 year old male presented with sudden severe abdominal pain and vomiting. He had no relevant medical history. Mechanical small bowel obstruction was confirmed on imaging and laparotomy revealed a nodular lead point in the submucosa of the ileum. He had resection of a segment of small bowel with a primary anastamosis. Histopathology of the lesion demonstrated myoepithelial hamartoma (MEH), a rare cause of intussusception. Discussion: Although intussusception is not uncommon in children, it is rare in adults. Management delays are a major cause of morbidity. This report details our management of a case of intussusception caused by MEH in an otherwise healthy adult. Conclusion: Intussusception caused by MEH is a rare but serious cause of mechanical bowel obstruction. We propose that surgeons should consider this diagnosis in atypical cases of bowel obstruction and expedite laparotomy when it is suspected