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Abstract: Trauma is the leading cause of death in the first few decades of life and the third most common cause of death in all age groups. Abdominal and pelvic injuries contribute to about 20% of fatalities. Experience in the USA suggests that prompt assessment and therapy are best delivered by specialized trauma centres. There are no specialized centres in the UK, therefore all surgeons and surgical trainees must have a thorough knowledge of trauma management. Recently there have been several changes in the epidemiology, diagnostic modalities and therapeutic options in the management of abdominopelvic injuries. This contribution should be read in conjunction with Brooks/Barker, page 190. [Copyright &y& Elsevier]

The article features British physician John Vetch and his efforts to find treatment for the eye infection called trachoma. He was born in 1783 in East Lothian, Scotland. Vetch served as assistant surgeon in the British Light infantry, accompanying the military troops fighting Napoleon in Egypt. He later become principal medical officer at the General Hospital for ophthalmic cases in the army. His book "An Account of the Ophthalmia" established his reputation as an expert in ophthalmias.

The article focuses on the voluntary organisations that provide professional counseling and informal support to people with sight loss in Great Britain.

The article features a 54-year old Caucasian male patient who was diagnosed of iritis in Great Britain. The patient was presented to the Cole Eye Institute for a second opinion of the patient's case, who suffered an ongoing redness, pain and photophobia in the right eye. He was treated with topical prednisolone acetate 1% without improvement. Another prescription was given to the patient but still to no relief and his symptoms worsened. Also discussed ware the details of his diagnosis.

Background: High-quality surgical care is vital to deliver the excellent outcomes patients deserve following surgical treatment. Quality improvement collaboratives (QICs) are based on a multicentre model for improving healthcare. They are increasingly used but their effectiveness in the context of surgical services is unclear. This review assessed effectiveness of QICs in National Health Service (NHS) surgical settings, and identified factors that influenced implementation., Methods: A systematic search of MEDLINE and EMBASE, as well as grey literature, was conducted in January 2022 to identify evaluations of QICs in NHS surgical settings. Data were extracted on the intervention, setting, study results and factors that were identified as facilitators or barriers. These were coded using the Consolidated Framework for Implementation Research (CFIR). The quality of study reports was assessed using Quality Improvement Minimum Criteria Set., Results: Fifteen reports on 10 QICs met inclusion criteria. The evaluations used study designs of different strength, with one using a stepped-wedge randomised controlled trial (RCT). Eight studies reported the QIC had been successful in achieving their principal aims, which covered a mix of patient outcomes and process indicators. The study based on the RCT found the QIC was not successful (no improvement in patient outcomes). Each article reported a range of facilitators and barriers to effectiveness of implementation of the QIC, which were spread across the CFIR domains (intervention, outer setting, inner setting, individuals and process). There were few barriers reported in the intervention domain that related to the QIC. There was no clear relationship between numbers of facilitators and barriers reported and effectiveness., Conclusions: Studies have reported QICs to be effective in increasingly complex contexts, but their results must be treated with caution. The evaluations often used weak study designs and the quality of reports was variable. Evaluation with strong study design should be integral to future QICs., Prospero Registration Number: CRD42022324970., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this study was to evaluate the effect of pre-operative intravenous thrombolytic therapy (ivTT) on short term outcomes after carotid endarterectomy (CEA) among patients who presented with ischaemic stroke., Methods: A retrospective study using a large population based dataset from the National Vascular Registry in the United Kingdom (UK-NVR). The cohort included adult patients who underwent CEA for ischaemic stroke between 1 January 2014 and 31 December 2019. NVR records provided information on patient demographics, Rankin score, medication, time from onset of symptoms to surgery and whether the patient received ivTT prior to surgery. Logistic regression was used to evaluate the relationship between ivTT and rates of any stroke at 30 days after CEA and in hospital complication rates for neck haematoma. Secondary outcomes included in hospital cardiac and respiratory complications, and cranial nerve injury., Results: Between 2014 and 2019, 9 030 patients presented with a stroke and underwent CEA, of whom 1 055 (11.7%) had received pre-operative ivTT. Those receiving ivTT were younger (mean 70.6 vs. 72.0 years, p < .001). The median (IQR) time from symptom to CEA was 10 days (6 - 17) for ivTT patients and 11 days (7 - 20) for CEA patients not receiving ivTT. Post-operative rates of 30 day stroke were similar between the no ivTT (2.1%) and ivTT (1.8%) cohorts (p = .48). In hospital neck haematomas were statistically significantly more common in CEA patients receiving ivTT (3.7%) vs. no ivTT (2.3%) (p = .006). There was no statistically significant association between 30 day stroke and neck haematoma complications when stratified for delays from symptom onset to CEA, but the overall cohort contained few adverse events for analysis during the very early time period., Conclusion: The use of ivTT before CEA in stroke patients was not associated with an increased risk of 30 day stroke, but there was an increase in the risk of neck haematoma., (Copyright © 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)