Recent NICE guidance of interest to surgeons

Quality standards are a set of statements about measurable components of high quality and cost effective care. They are based on consideration of effectiveness, patient safety and patient experience. Quality standards are designed to be aspirational but achievable. Commissioners will use them in setting contracts. The quality standard on colorectal cancer was published in August 2012 and has eight key statements: Statement 1: People with suspected colorectal cancer without major co-morbidity are offered diagnostic colonoscopy. Statement 2: People with colon cancer are offered contrast enhanced computed tomography (CT) of the chest, abdomen and pelvis to determine the stage of the disease. Statement 3: People with rectal cancer are offered contrast enhanced CT of the chest, abdomen and pelvis to determine the stage of the disease, and pelvic magnetic resonance imaging to assess the risk of local recurrence. Statement 4: People with rectal cancer are offered a preop-erative treatment strategy appropriate to their risk of local disease recurrence. Statement 5: People with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (<1mm) are offered further surgery or active monitoring. Statement 6: People with contrast enhanced CT of the chest, abdomen and pelvis suggesting liver metastatic colorec-tal cancer have their scans reviewed by the hepatobiliary multidisciplinary team to decide whether further imaging is needed to confirm suitability for surgery. Statement 7: People with locally advanced or metastatic colorectal cancer whose disease progresses after first-line systemic anticancer therapy are offered second-line systemic anticancer therapy if they are able to tolerate it. Statement 8: People free from disease after treatment for colorectal cancer are offered regular surveillance. The full text of the quality standard provides more detail about what each statement means for different audiences, including clinicians, patients and commissioners. It also provides links to the evidence underpinning the statements and to related guidance. This is about 'diathermy'! The Mega Soft (Megadyne, Draper , UT, US) system replaces a standard adhesive monopo-lar diathermy plate with a pressure relieving mattress that remains on the operating table and is cleaned between patients. It contains an electrode that has much more extensive contact with the patient than a standard adhesive pad. The evidence supported the claim that Mega Soft may offer advantages for some patients by: (a) avoidance of shaving for application of adhesive pads and (b) avoidance of adhesive for those with fragile or damaged skin. Use of Mega Soft also …