Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Sep 1994
The acute surgical admission: is mortality predictable in the elderly?
Most scoring systems used to predict mortality are complex. A simple preoperative assessment, the Sickness Assessment (SA), was evaluated as a predictor of mortality in elderly patients admitted as surgical emergencies. The three parameters comprising the SA are: hypotension on admission, the presence of severe chronic disease, whether the patient was independent and self-caring. ⋯ The predictive ability of the APACHE II score was not superior to SA. The SA is a simple preoperative assessment which identifies a high-risk group. It should be used in emergency surgical practice to improve outcome and avoid inappropriate surgery.
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A prospective study of the effectiveness of local anaesthesia in arthroscopy of the knee was performed in 212 consecutive patients. Arthroscopic surgery was undertaken successfully in 121 cases (57%), including meniscectomy and drilling of osteochondral defects. Dynamic evaluation of the patellofemoral joint articulation was possible and demonstration of pathological abnormalities was felt to be beneficial by some patients. ⋯ Only ten patients complained of moderate pain, none had severe pain. Local anaesthesia is contraindicated in cases with ipsilateral osteoarthritis of the hip or with significant synovitis of the knee. This technique is particularly suited to day case surgery.
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Ann R Coll Surg Engl · Sep 1994
Reduction in junior doctors' hours in an otolaryngology unit: effects on the 'out of hours' working patterns of all grades.
This study aimed to assess the effects of recent controls on juniors' duty hours (the 'New Deal') on the work performed by all grades of ENT medical staff 'out of hours'. For 100 days in 1993 the out of hours duties of all grades of doctor in the Otolaryngology Unit were monitored using daily logs. Three patterns of cover were run in parallel and subjected to comparison: Light: Senior House Officer (SHO)--Consultant (CON); Traditional: SHO-Intermediate (Registrar or Senior Registrar)--Consultant; Cross-cover--Pre-Registration House Officer (PRHO)--Intermediate-Consultant. ⋯ Reduction in on-call hours of junior staff resulted in a need for cross-cover and also in the frequent removal of an intermediate tier of staff. This has been shown to have a considerable effect on working patterns for intermediate and senior grades in an ENT unit of average size. Further reductions would be expected to have major effects on the working patterns of the consultant grade and considerably dilute the emergency experience of trainees.
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Surgical training in the United Kingdom is undergoing a radical reorganisation but included in these changes are plans for the continued participation of foreign graduates in the new training programmes. British surgery has a long tradition of contributing to the training of foreign graduates but unfortunately in the past the organisation of this training was often haphazard although it did coincide with a time when the organisation of surgical training for all graduates was equally patchy. Nevertheless, the overall high standard of training has resulted in an equitable distribution of well-trained surgeons throughout the United Kingdom, most of whom are keen to participate in the evolving surgical training programmes. The purpose of this paper is to help foreign trainers and trainees understand the present training position and encourage their participation in the new programmes.
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Ann R Coll Surg Engl · Jul 1994
From hospital to production line: the price of modern surgical bed management?
A global analysis of surgical bed dynamics in a District General Hospital over a typical 18 working day period is presented. All surgical specialties are represented. A total of 2,484 bed days were studied. ⋯ Fifteen per cent of beds were closed for financial reasons. The study of admission and the stay and discharge policies of different specialties indicated that potential cost improvements could be made by the introduction of more day surgery, day of surgery admission, efficient discharge, ring fencing of beds and improved hospital data collection. While these recommendations are financially desirable, their impact on patients and staff remains to be seen.