Annals of the Royal College of Surgeons of England
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Some achievements in the treatment of congenital heart defects are discussed. Special comments are made about the persistent ductus arteriosus, atrial septal defect, transposition of the great arteries and the Fontan operation. The differences and similarities between 'corrective' and 'palliative' operations are discussed. ⋯ Current and future training of paediatric cardiac surgeons is discussed and proposals made for the future organisation of care for children with congenital heart defects. The author speculates about how these problems will be solved in view of the decreasing number of children with congenital heart defects. Impact of treatment on the families of patients with congenital heart defects is also considered.
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Although a higher surgical degree is considered de rigeur for trainees aspiring to the senior registrar grade in general surgery (2,7,4) the same does not appear to be true of orthopaedic surgery. Fifty of 51 registrars and senior registrars in orthopaedic surgery in the North East Thames Region completed a carefully structured and confidential questionnaire which focused on two major aspects. For those who had not undertaken a period in full time research, questions examined future intentions in this area, and the reasons for those intentions. ⋯ For the orthopaedic trainee full-time research is considered a positive choice rather than a hurdle. Trainees also feel they are well supervised and find the exposure to research stimulating and satisfying. This is in clear contrast with the experience of those in general surgery.
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Ann R Coll Surg Engl · Jan 1995
The trauma team concept and its implementation in a district general hospital.
A trauma team approach to the initial assessment, investigation and treatment of potentially seriously injured patients has been implemented at a district general hospital. Team members are mobilised by an emergency paging system which is activated when a patient fulfils one or more of a predetermined list of historical, pathophysiological and anatomical criteria. Aspects of the function of the trauma team were assessed after 10 months of operation. ⋯ Although hospitals differ in workload and staffing, the trauma team concept is possible and achievable at no extra cost. Trauma teams maximise existing resources and constitute a valid approach to the early management of the irregular presentation of the severely injured patient to district general hospitals. The establishment of such teams with members who should be ATLS trained, should be a current priority in district general hospitals in the UK.
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Ann R Coll Surg Engl · Jan 1995
Randomized Controlled Trial Clinical TrialIs there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?
The benefits of parenteral non-steroidal analgesic drugs and low molecular weight heparin anticoagulants have been shown before, but there is concern that the use of these agents in combination may potentiate haemorrhagic side-effects because of simultaneous inhibition of the clotting cascade and platelet mechanisms of haemostasis. In a prospective controlled trial, 60 patients undergoing total hip replacement were randomised into two groups. Those in one group received intramuscular ketorolac and those in the other group opioid analgesia. ⋯ There were 34 patients in the NSAID group and 26 in the opiate group. There were no significant differences between the two groups for intraoperative blood loss, postoperative drainage, transfusion requirements, bruising, wound oozing and leg swelling. From this study it would appear that there is a low risk of significant haemostatic potentiation associated with concurrent use of low molecular weight heparin and a modest dose of ketorolac tromethamine.