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ispartof: BRITISH JOURNAL OF SURGERY vol:109 issue:6 pages:493-496 ispartof: location:England status: published

Aim: Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. Method: This international patient–provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of LARS. Results: Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. Conclusion: This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.

Background\ud Ileus is common after gastrointestinal surgery and has been identified as a research priority. Several issues have limited previous research, including a widely accepted definition and agreed outcome measure. This review is the first stage in the development of a core outcome set for the return of bowel function after gastrointestinal surgery. It aims to characterize the extent of variation in current outcome reporting.\ud \ud Methods\ud A systematic search of MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library was performed for 1990–2017. RCTs of adults undergoing gastrointestinal surgery, including at least one reported measure relating to return of bowel function, were eligible. Trial registries were searched across the same period for ongoing and completed (but not published) RCTs. Definitions of ileus and outcome measures describing the return of bowel function were extracted.\ud \ud Results\ud Of 5670 manuscripts screened, 215 (reporting 217 RCTs) were eligible. Most RCTs involved patients undergoing colorectal surgery (161 of 217, 74·2 per cent). A total of 784 outcomes were identified across all published RCTs, comprising 73 measures (clinical: 63, 86 per cent; radiological: 6, 8 per cent; physiological: 4, 5 per cent). The most commonly reported outcome measure was ‘time to first passage of flatus’ (140 of 217, 64·5 per cent). The outcomes ‘ileus’ and ‘prolonged ileus’ were defined infrequently and variably.\ud \ud Conclusion\ud Outcome reporting for the return of bowel function after gastrointestinal surgery is variable and not fit for purpose. An agreed core outcome set will improve the consistency, reliability and clinical value of future studies.

This photo essay accompanies a short film, A Break in the Clouds, which explores everyday life in Mosser, a small former township on the north-west edge of the Lake District. Prompted by the historical diaries of two eighteenth-century Quaker farmers from the same area, connections were drawn between the experiences of the current farmers and those in the past. The text discusses those connections, the making of the film, and how our approach was designed to democratise the research process. The images, selected by the photographer, reflect on the key themes or ‘spaces’ that emerged during the research: home/work, land/family, landscape/weather.

AIM: In order to develop its education agenda, the ACPGBI sought the opinion of its members on current coloproctology training needs. The aims of this study were to canvass multi-disciplinary needs and explore the perceived gaps and barriers to meeting them. \ud \ud METHOD: A learner needs analysis was performed between July 2015 and October 2016. A bespoke electronic survey was sent to 1,453 colorectal health care professionals (ACPGBI membership (1,173), colorectal nurse specialists and allied health professionals (NAHP) (261) and regional chapter-leads (19)) seeking their needs, experiences and barriers to training across the coloproctology disciplines. \ud \ud RESULTS: 390 responses were received (26.8% overall; 180 consultants/trainees (15%); 196 NAHP (75%); 14 (74%) chapter-leads). Lack of funding and difficulties in obtaining study leave were the most frequently reported barriers to course and conference attendance. Transanal total mesorectal excision and laparoscopic training were the top educational needs for consultants and trainees respectively. 79% of NAHP respondents reported education gaps on a broad range of clinical and non-clinical topics. NAHP lacked information on relevant training opportunities and 27% felt available courses were insufficient to meet their educational needs. Wide heterogeneity in ACPGBI chapter composition and activity was reported. All groups felt the ACPGBI should increase the number of courses offered with coloproctology knowledge updates commonly requested. \ud \ud CONCLUSION: A series of training needs across the coloproctology disciplines have been identified. These will underpin the development of the educational agenda for the ACPGBI.

BACKGROUND: The applications of new diagnostic technologies such as near patient tests are relevant to the further development and potential of primary care. Through their use, doctors in the community may increase the accuracy of their diagnoses and improve their ability to monitor disease. A reliable indicator of disease activity in various clinical conditions is C-reactive protein (CRP) and a near patient test for this is now available, although there is little information on its use outside hospitals. AIM: A study was set up to evaluate the feasibility of using a novel near patient test for CRP in primary care to validate the results against the laboratory "gold standard' for CRP (Beckman Array) and to compare results with the usual inflammation test used in general practice. METHOD: Prospective recording of CRP as a near patient test on an "intention to investigate' basis, with validation of results against the Beckman Array system for CRP and hospital laboratory erythrocyte sedimentation rate results, in six general medical practices in Birmingham. Main outcome measures were change in local laboratory usage, characteristics of patients chosen for testing, use of quality control, and comparison of readings with results from the same sample sent to an independent laboratory. RESULTS: Tests of CRP levels were rarely requested before the study was undertaken. During the 3-month study period, 181 near patient tests were carried out, 146 (81%) to establish a diagnosis and the remainder for disease monitoring. Out of the tests, 67% were performed by general practitioners, mostly during the consultation itself. Using a cut-off level of 10 mg I-1, the near patient test and the Beckman Array gave results which agreed in 84% of cases. The sensitivity and specificity of the near patient test results were 97 and 79%, respectively. The predictive value of a positive result was 59% and that of a negative result was 99%. Cohen's Kappa was 62% and the overall mean bias for results in the range of the test was 6.11 mg I-1 (SE = 3.07 mg I-1). Each test took 6 min on average to perform, including all preparations, blood letting, performing the test and averaging the time for quality control estimations. The cost per test averaged pounds 1.72, rising to pounds 4.17 including labour, capital costs, quality controls and consumables (general practitioner performing the assay at average frequency found in this study). CONCLUSIONS: Measurement of CRP is rarely used in primary care and awareness of its value could be raised. This near patient test proved feasible for use by general practitioners and practice nurses. Its reliability compared with a laboratory result was satisfactory overall, and excellent with adequate operator technique.

Postharvest technology is predicted to experience a transformation over the next couple of decades. Some of the changes may be wrought by as yet unforeseen developments in science, but others will result from the rapid evolution of computer software and hardware. Commercial software is presently available that integrates many strands of engineering science such as structural mechanics, the flow of particulate solids, the distribution of gases within buildings and thermal analysis. The software also enables interactions between these various processes, and the approach is referred to as multi-physics. Commercially available software can be tailored to account for biological phenomena such as the effects of the microenvironments in grain stores on the viability of seeds, the rate of decay of pesticides, the propensity of insect populations to increase and so on. The time is ripe to integrate these chemicobiological aspects of grain storage with multi-physics to form what might be dubbed an omni-scientific approach to postharvest technology. The development of such an approach will help unify the disparate sciences involved in grain handling, and it will provide an explicit overarching intellectual framework into which individuals' work will fit. Information and communications technology will not only enable technical problems to be addressed, but it will enable a range of specialists to contribute simultaneously to solving particular problems. Such a scenario will have a profound effect on the postharvest profession, and it will require a radically new approach to the education and formation of stored grains technologists. These specialists must continue to have deep knowledge of specialised areas of science such as genetics, analytical chemistry, fluid dynamics and so on, but they must also be familiar with the integrating software tools and a broad range of science. Postharvest professionals will need to be familiar with several scientific disciplines, i.e. they will need to be omni-scientists, whilst recognising that omniscience is unattainable.

International audience; no abstract