Anaesthesia
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A retrospective analysis of 509 consecutive interscalene catheter insertions for ambulatory surgery.
Effective pain therapy after shoulder surgery is the main prerequisite for safe management in an ambulatory setting. We evaluated adverse events and hospital re-admission using a database of 509 interscalene catheters inserted during ambulatory shoulder surgery. ⋯ Twelve (2.4%) patients were re-admitted to hospital (8 (1.6%) for pain, 2 (0.4%) for dyspnoea and 2 (0.4%) for nausea and vomiting), 9 of whom had rotator cuff repair. A well-organised infrastructure, optimally trained medical professionals and appropriate patient selection are the main prerequisites for the safe, effective implementation of ambulatory interscalene catheters in routine clinical practice.
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We describe the development and laboratory assessment of a refined prototype tactile feedback device for the safe and accurate application of cricoid pressure. We recruited 20 operating department practitioners and compared their performance of cricoid pressure on a training simulator using both the device and a manual unaided technique. ⋯ Most importantly, the percentage of force applications that deviated from target by more than 10 N decreased from 18% to 7% (p < 0.01). The device requires no prior training, is cheap to manufacture, is single-use and requires no power to operate, whilst ensuring that the correct force is always consistently applied.
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There is both medical and political drive to centralise secondary services in larger hospitals throughout the National Health Service. High-volume services in some areas of care have been shown to achieve better outcomes and efficiencies arising from economies of scale. ⋯ The intention is that the model should be generic and transferable for those looking to merge and rationalise services on to one site. One of the advantages of mathematical modelling is the ability to interrogate the model to investigate any number of different scenarios; some of these are presented.
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Editorial Comment
Rumsfeld revisited: knowns and unknowns affecting the right heart.