Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 2002
Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UK.
Current peri-operative fluid and electrolyte management in the UK may be suboptimal. We assessed the attitudes of consultant surgeons to fluid and electrolyte prescribing and gathered suggestions for improvement in education on the subject. ⋯ Consultant surgeons feel that present practice in peri-operative fluid management is unsatisfactory. Higher standards within clinical governance and risk management may be achieved by focused practical training combined with formal written guidelines.
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A recent survey of UK general surgeons showed that almost 90% prefer to manage patients with acute cholecystitis by initial conservative management and delayed cholecystectomy (DC). The aim of this study was to assess the effectiveness of this management policy in a large university hospital. ⋯ The policy of conservative management and DC was successful in 60.6% of cases but 14.7% of patients required emergency surgery and 24.8% were re-admitted prior to elective surgery with a resultant increase in total hospital stay. Performing elective surgery within 2 months of discharge in all cases would have reduced the re-admission rate by 56% and this along with the increased use of early cholecystectomy during the first admission are areas where the treatment of acute cholecystitis could be significantly improved.
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Ann R Coll Surg Engl · Jan 2002
Can a district general hospital serving a population of 480,000 offer subspecialty training? --A prospective audit.
Subspecialty training has been mostly restricted to teaching hospitals. We aimed to assess whether higher surgical trainees can be offered subspecialty training in a district general hospital serving a large population. ⋯ 50% of the workload on the vascular, breast/endocrine and colorectal firms is subspecialty-related with the potential for training. With shortened training and some specialities having disproportionately more trainees, higher surgical training committees need to identify more subspecialty units that offer such training.
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Pulmonary thromboendarterectomy (PTE) provides a curative alternative to the otherwise fatal condition of chronic thromboembolic pulmonary hypertension (CTEPH). However, the condition is under-diagnosed due to a lack of awareness. ⋯ Outcome is further optimised if the disease is diagnosed early and patients referred to specialised centres. An increase in the number of surgical procedures will also contribute to lower the mortality associated with this condition.