British journal of neurosurgery
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No published guidelines exist for how receiving unit doctors should manage referrals. Feedback regarding the quality of neurosurgical referral handling in our hospital has, in the past, been poor. We designed a novel means to appraise specialist referral handling, such that service delivery could be improved. We also aimed to identify differences, if any, between doctor perceptions versus actual satisfaction with the on-call neurosurgery service in our centre. ⋯ We describe a novel method for receiving units to appraise their referral services and demonstrate its usefulness in our tertiary neurosurgical unit. We also demonstrate that most referring doctors are satisfied with the handling of their neurosurgical referrals, despite perceptions to the contrary.
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In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). ⋯ An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.
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Student-selected components (SSCs) are protected periods of time in the undergraduate medical curriculum which allow students to explore an area of medicine they are interested in. They are particularly valuable in exposing students to smaller specialties like neurosurgery, which are often sparsely covered in the rest of the undergraduate curriculum. Moreover, they provide opportunities for students interested in pursuing a career in neurosurgery to increase their likelihood of being successful in specialty training applications. ⋯ Furthermore, we have set out to establish a series of achievable objectives over the course of a typical SSC in neurosurgery. This includes the possibility of participation in research and audit, which, if well planned, can be rewarding for both the student and the host unit. SSCs are an effective means of exposing medical students to neurosurgery and provide a multitude of opportunities for enhancing clinical competencies and career development.