Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Sep 1994
Clinical Trial Controlled Clinical TrialPrevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine.
Phantom limb pain may appear in up to 85% of patients after amputation. There is no effective treatment. Perioperative epidural infusion of morphine and bupivacaine, alone or in combination, is effective in preventing phantom limb pain in patients with pre-existing limb pain. ⋯ At 1 year follow-up, one patient in the study group and eight patients in the control group had phantom pain (P < 0.002) and two patients in the study group versus eight patients in the control group had phantom limb sensation (P < 0.05). There was no significant improvement in stump pain. We conclude that perioperative epidural infusion of diamorphine, clonidine and bupivacaine is safe and effective in reducing the incidence of phantom pain after amputation.
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Ann R Coll Surg Engl · Sep 1994
The acute surgical admission: is mortality predictable in the elderly?
Most scoring systems used to predict mortality are complex. A simple preoperative assessment, the Sickness Assessment (SA), was evaluated as a predictor of mortality in elderly patients admitted as surgical emergencies. The three parameters comprising the SA are: hypotension on admission, the presence of severe chronic disease, whether the patient was independent and self-caring. ⋯ The predictive ability of the APACHE II score was not superior to SA. The SA is a simple preoperative assessment which identifies a high-risk group. It should be used in emergency surgical practice to improve outcome and avoid inappropriate surgery.
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Surgical training in the United Kingdom is undergoing a radical reorganisation but included in these changes are plans for the continued participation of foreign graduates in the new training programmes. British surgery has a long tradition of contributing to the training of foreign graduates but unfortunately in the past the organisation of this training was often haphazard although it did coincide with a time when the organisation of surgical training for all graduates was equally patchy. Nevertheless, the overall high standard of training has resulted in an equitable distribution of well-trained surgeons throughout the United Kingdom, most of whom are keen to participate in the evolving surgical training programmes. The purpose of this paper is to help foreign trainers and trainees understand the present training position and encourage their participation in the new programmes.
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Ann R Coll Surg Engl · Jul 1994
From hospital to production line: the price of modern surgical bed management?
A global analysis of surgical bed dynamics in a District General Hospital over a typical 18 working day period is presented. All surgical specialties are represented. A total of 2,484 bed days were studied. ⋯ Fifteen per cent of beds were closed for financial reasons. The study of admission and the stay and discharge policies of different specialties indicated that potential cost improvements could be made by the introduction of more day surgery, day of surgery admission, efficient discharge, ring fencing of beds and improved hospital data collection. While these recommendations are financially desirable, their impact on patients and staff remains to be seen.