Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Mar 1994
Out-of-hours workload of junior and senior house surgeons in a district general hospital.
The objective of this study was to assess the out-of-hours workload of junior and senior house officers in general surgery working in a busy DGH in relation to the 'New Deal' guidelines on junior doctors' hours of work. We also wanted to identify safe levels of manning for these grades of staff and to collect accurate data on workload upon which decisions could be made regarding any change in manning levels consequent upon the 'New Deal'. The study is a prospective audit of all work undertaken by 11 junior and senior house surgeons attached to six consultants between 1700 hrs and 0800 hrs during a 16-day period in August 1992. ⋯ Non-medical tasks accounted for 29 per cent of the ward doctors working time but were a small part of the other doctors work. It was concluded that in this typical busy DGH junior and senior house officers work extremely hard when on call, and that they cannot be reasonably be asked to further increase their level of activity. It follows that a reduction in the hours of work will require additional staff if the standard of care delivered to the patients is to be maintained.
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Ann R Coll Surg Engl · Mar 1994
Gunshot wounds of the spine: should retained bullets be removed to prevent infection?
We have investigated the role of retained bullets and other possible risk factors in the development of local septic complications after gunshot wounds (GSW) of the spine. Of 153 patients with GSW of the spine followed up for a mean of 28 months, the overall incidence of bullet wound related septic complications was 9.8%. In 81 patients the bullet was retained and the incidence of local septic complications was 7.4%. ⋯ In 24 patients there was an associated colonic injury and the incidence of sepsis was 8.4% compared with 5% in the group of patients with intra-abdominal injuries but no colonic trauma (P > 0.05). The incidence of septic complications in lumbar spine injuries was significantly higher than in thoracic and cervical spine injuries (P > 0.05). We believe that in GSW of the spine, retained bullets do not increase the likelihood of septic complications.
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Ann R Coll Surg Engl · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialProlonged suction drainage prevents serous wound discharge after cardiac surgery.
A series of 180 patients was randomised to two groups after median sternotomy performed for cardiac surgery in order to evaluate the effect of suction drainage on serous wound discharge. In group A all wounds were drained using two conventional mediastinal drains, while in group B one suction drain and one conventional mediastinal drain were employed. Five patients developed serous wound discharge in group B compared with 14 in group A (chi 2, P < 0.02). There were no significant differences between the rates of major wound infection (group A, n = 1; group B, n = 1) or the incidence of postoperative pericardial effusion assessed by echocardiography (group A, n = 10; group B, n = 5).
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All 338 lower limb amputees under the care of one disablement services centre were asked to assess phantom pain severity at different times after amputation. Of 212 (63%) replies, 13 had died, 22 were non-limb wearers and 22 were unable to complete the questionnaire. In all, 176 useful replies were received--96 below-knee, 74 above-knee and 6 through-knee. ⋯ Phantom pain decreased with time, was present equally in traumatic and vascular amputees, and was related to the amount of preoperative pain (P < 0.005). Only 22% felt phantom pain had impaired their rehabilitation. Rehabilitation score was related to phantom pain severity at the time of questionnaire completion (P < 0.05), but not at other specified times after operation.