Scot Med J
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National guidelines exist for the treatment of acute gallstone pancreatitis, but not for the management of acute cholecystitis (AC). ⋯ The majority of surgeons (over 60%) manage AC with same admission LC. Of those who do not, more than a third report lack of resources as being the reason. The majority of surgeons in the West of Scotland manage mild gallstone pancreatitis in accordance with current guidelines.
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Biography Historical Article
Scotland, Malawi and medicine: Livingstone's legacy, I presume? An historical perspective.
In this personal short historical perspective I reflect on aspects of the medical history of Malawi, formerly Nyasaland, highlighting the role of Scotland and its people in the development of the Malawi medical services in both the colonial as well as the postcolonial period which began in 1964. The paper, after discussing the history of medical training in Malawi and current constraints and challenges, goes on to make some suggestions - based on historical lessons - about future role of Scottish involvement in Malawi's medical development. It would be unfortunate if, in a rush to 'help or do something' the mistakes of the past are repeated.
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Troponin I (TnI) measurement is important in decision making and management of patients who present with chest pain. Undetectable levels of TnI in these patients are associated with a low risk of death or myocardial infarction at 30 days, and may allow early discharge from hospital. ⋯ A fast-track troponin and specialist nurse achieved a reduction of nearly 24 hours in length of stay in patients presenting with chest pain. This would result in a saving of approximately 2000 bed-days per annum, releasing 5-6 acute beds per day.
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The malposition of endotracheal tubes (ETTs) can be associated with endo-bronchial intubation or accidental extubation. A variety of methods have been reported for predicting insertional length (IL) including weight, nasal-tragus length (NTL) and sternal length (STL) measurements. In our unit no consistent predictor method was being used. ⋯ The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.
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As the population presenting for day-case surgery and anaesthesia increases, so does the challenge of adequate pre-operative assessment. The resting 12-lead electrocardiogram (ECG) is relatively insensitive and frequently normal even in the presence of severe coronary artery disease but it is quick, easy to perform and frequently requested, thus its value in day-case surgery remains unproven. ⋯ The finding of ECG abnormalities did not prevent the patient proceeding directly to anaesthesia and surgery. Furthermore, they did not predict intra-operative, postoperative complications or hospital admission following the procedure. The ECG is of limited value in the risk stratification of patients selected for day-case surgery.