Annals of the Royal College of Surgeons of England
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Published guidelines recommend early transfer of patients with hip fractures to hospital wards and avoidance of unnecessary delays in A&E. We describe a protocol whereby the liaison of an orthopaedic trauma co-ordinator with A&E reduced A&E-to-ward transfer times by 43%. Following introduction of the new protocol, 39% of hip fracture patients were in a ward bed within 3 h of admission to A&E compared to 4% previously. The new protocol also reduces administrative workload for the on-call orthopaedic SHOs.
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Ann R Coll Surg Engl · Mar 2003
Current practice in the use of antiplatelet agents in the peri-operative period by UK vascular surgeons.
There currently appears to be no firm consensus with regards to the use of antiplatelet agents during the peri-operative period in vascular surgical practice. ⋯ Although the benefits of antiplatelet drugs in the long-term reduction of vascular events is established, evidence supporting their use in the peri-operative period is scarce. The general consensus of opinion from this survey suggests that most vascular surgeons do not stop antiplatelet drugs pre-operatively.
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Ann R Coll Surg Engl · Nov 2002
The experience and training of British general surgeons in trauma surgery for the abdomen, thorax and major vessels.
The report Better Carefor the Severely Injured [London: The Royal College of Surgeons of England and the British Orthopaedic Association; 2000] states that an experienced general surgeon trained in the techniques required to perform life-saving emergency surgery is vital in the management of major trauma. The experience and training of general surgeons in the UK in the management of trauma to the abdomen, thorax and major vessels has never been assessed. ⋯ There is limited experience and training in the surgical management of torso trauma in the UK. Implementation of the recommendations from Better Care for the Severely Injured will be hampered unless steps are taken to maximise experience and improve training.
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Ann R Coll Surg Engl · Jul 2002
An audit on the blood transfusion requirements for revision hip arthroplasty.
The hospital transfusion committee of Swindon and Marlborough NHS Trust had formulated a maximum surgical blood ordering schedule (MSBOS) which included the standard practice of 6 units of blood for revision hip arthroplasty. A retrospective audit of 73 patients who underwent revision hip arthroplasty over a year was undertaken to identify current practice and to ensure that the standard was adequate for patient safety. Information regarding the number of units requested, number of units transfused, pre-operative haemoglobin (Hb), lowest postoperative Hb and number of additional units of blood requested within 3 days postoperatively, was collected from patients' case-notes. ⋯ Of cross-matched units, 92.3% were used when pre-operative Hb was < 12 g/dl, 64.4% were used when Hb was between 12.1-13.0 g/dl, 54.3% were used when the Hb was between 13.1-14.0 g/dl, 38.9% were used when Hb was between 14.1-15.0 g/dl and 39.7% used with pre-operative Hb of > 15.0 g/dl. Of the total, 14 patients had a postoperative Hb of < 9 g/dl for whom additional units of blood were ordered and given to achieve a Hb of between 10.1-14.2 g/dl prior to discharge. This audit suggests that in patients with pre-operative Hb of 13 g/dl or more, the cross-match could be 4 units instead of 6 units for revisions.
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Ann R Coll Surg Engl · May 2002
A 5-year study of the outcome of surgically treated depressed skull fractures.
Many changes and improvement have taken place in the management of head injured patients in the last 20 years. There have been few recent studies analysing the overall outcomes including early complications of depressed skull fractures. The aim of our study was, therefore, to examine the factors influencing the surgical outcome of patients with depressed skull fractures. ⋯ Paediatric populations have better outcome; 7 out of 10 patients in this series progressed to full recovery. Use of prophylactic antibiotics did not reduce the infection rate. Presence of dural tear was not associated with an increase risk of post-traumatic epilepsy.