Annals of the Royal College of Surgeons of England
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A study into how pre-operative skin preparation varies between surgical units and surgeons. ⋯ There is variation in the method of skin preparation employed between surgical units and surgeons. There is limited evidence-based research on this topic. Recommendations are made as to best practice.
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Critical illness is an emergency because the inflammatory response has redundant multiple pathways; once triggered, it is difficult to control or suppress. Infection is a potent precursor of critical illness and increasing organ dysfunction has a synergistic, rather than purely additive, adverse effect on mortality. The longer the inflammatory process continues unabated, the more advanced and unrecoverable the pathophysiological processes become resulting in a high mortality. ⋯ Formalising measurement of physiological (in)stability on the general ward using Early Warning Scores improves recognition of unstable and potentially critically ill patients. Prompt intervention will either reverse further physiological decline or facilitate timely referral to the critical care service for further, more invasive, organ support.
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Ann R Coll Surg Engl · Sep 2005
Multicenter StudyManagement of suspected scaphoid fractures in accident and emergency departments--time for new guidelines.
The objectives of this work were to assess the clinical knowledge of clinicians in the accident and emergency (A&E) departments in England & Wales and evaluate the current trend for the acute management of radiologically normal, but clinically suspected, fractures of the scaphoid. ⋯ The clinical knowledge and the management of suspected scaphoid fractures in A&E are unsatisfactory. We, therefore, suggest that the dissemination of up-to-date guidelines could help to educate clinicians to provide better care to the patients.
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Ann R Coll Surg Engl · Sep 2005
What impact will shortened training have on urological service delivery?
Modernisation of Medical Careers dictates a shortening of the training required to achieve consultant status. Precisely what type of work these consultants could be expected to accomplish, and be trained to do, is not clear. The objective of this study was to demonstrate a method of stratifying urological workload so as to determine what a urological trainee, undergoing shortened training, might be expected to do as a consultant and to use this stratification to help manpower planning within the specialty. ⋯ Shortened training seems able to satisfy the service delivery needs of the majority of out-patient and day-case urological activity. It will not, however, fulfil the need for subspecialty-based training required to cope with the large minority of patients necessitating complex surgical intervention. Specialist training programmes, promoting advanced operative skills, need to be evolved in parallel to shortened training so as to ensure global urological service provision for the future.