Journal of the Royal College of Surgeons of Edinburgh
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J R Coll Surg Edinb · Feb 1998
Minimizing the risk of penetrating injury to surgical staff in the operating theatre: towards sharp-free surgery.
Conventional surgery carries a significant risk of inadvertent injury to members of the scrub team. Although minor injury is common and usually no more than unpleasant, serious consequences may occur. Modifications in technique together with the application of modern instrumentation may reduce the risks of sharp injury substantially. The techniques and technology available in the conventional open surgery setting are reviewed.
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J R Coll Surg Edinb · Feb 1998
Profile of the first four years of the Regional Burn Unit based at St. John's Hospital, West Lothian (1992-1996).
In March 1992, the Regional Adult Burn Unit for the South East of Scotland in Bangour was transferred to the new District General Hospital in West Lothian. With the change in site and with changes in NHS policies and staff, it was expected that some difficulties would occur. An analysis of the initial situation was considered to be educational as well as of practical value. ⋯ Although the most common infectious organism in the Burn Unit remains Staphylococcus aureus, the advent of MRSA is worrying. The new unit has been closed twice because of bacterial infection. It is concluded that it is essential that patients with burns are managed in a separate Burn Unit within the District General Hospital and not amalgamated with other areas such as Intensive Care.
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J R Coll Surg Edinb · Dec 1997
Review Case ReportsAnaphylactic shock in a patient with ruptured hydatid liver cyst owing to trivial abdominal trauma.
A 16-year-old Libyan male was admitted to the Intensive Therapy Unit (ITU) of Zliten Central Hospital after he had been hit on the abdomen by a football, his main symptom was upper abdominal pain. The patient looked pale, was dyspnoeic and had an unrecordable blood pressure level. Abdominal examination revealed tenderness, guarding and rigidity all over the abdomen. ⋯ The patient received intravenous fluid, analgesia and oxygen by mask. Peritoneal lavage was performed and a small amount of sero-sanguineous fluid was expelled. After resuscitation measures his blood pressure rose and the patient was taken to the operation theatre for a laparotomy.
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Clinical audit is now an integral part of surgical practice. The Royal College of Surgeons of England has stated that all members of the clinical team should participate in the clinical audit. Junior surgical doctors from the West Midlands Region were interviewed, using a questionnaire, to investigate their attitudes towards audit. ⋯ In those hospitals in which all elective work was cancelled, there was a higher attendance rate at audit meetings by junior doctors. Many junior doctors felt that they lacked direction from senior colleagues and had not received any formal training in clinical audit. Clinical audit should become part of undergraduate and postgraduate medical training and junior doctors need to take a more active role in clinical audit.
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A nurse-led Pre-operative Assessment Clinic was introduced into the General Surgical Directorate at the Royal Hallamshire Hospital in August 1993 to provide a general medical and anaesthetic pre-operative assessment, to give information, both written and verbal, to patients about their operations and to identify social problems which might delay discharge. Patients were seen either at the time of their original clinic appointment or subsequently on a recall basis, prior to admission to hospital. The clinic was run by two out-patient nurses working to agreed protocols. ⋯ Eighteen per cent of investigations were repeated unnecessarily because the reports were unavailable or considered out of date. However, only 1% of patients pre-operatively assessed had their operations cancelled after their admission, compared with 6% of non pre-operatively assessed patients. Given the total number of patients admitted for surgical procedures per year, the introduction of comprehensive pre-operative assessment for all patients could result in a substantial reduction in cancellations following admission.