Surg J R Coll Surg E
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Surg J R Coll Surg E · Jan 2011
ReviewImpact of reduced working time on surgical training in the United Kingdom and Ireland.
The European Working Time Directive (EWTD) 48 h working week has been law in European countries since 1998. A phased approach to implementation was agreed for doctors in training, which steadily brought down working hours to 58 in 2004, 56 in 2007 and 48 in 2009. ⋯ Shorter sessions of work have led to complex rotas, frequent handovers with difficulties maintaining continuity of care with implications for patient safety. Although there has been over 10 years notice of the changes to the working week and progress has up to now been reasonable (helped, in part by a steady increase in consultant numbers) this latest reduction from 56 h to 48 h seems to have been the most difficult to manage.
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Surg J R Coll Surg E · Oct 2010
Clinical presentation and waiting time targets do not affect prognosis in patients with pancreatic cancer.
The prognosis of patients with pancreatic cancer remains poor despite recent advances in treatment. It is not known whether delays in referring, diagnosing and treating these patients and the way they present can affect their survival. ⋯ This study showed that pre-hospital delays in referring patients to a specialist unit, but not hospital related 62 days target, had an no impact on operability, resectability and survival. Clinical presentation also had no impact on the survival. We confirmed that pancreatic resection is the most important factor in determining the length of survival in patients with pancreatic cancer. Our study implies that the successful implementation of the 62 days National Cancer Waits Target across the UK is unlikely to have an impact on prognosis in patients with pancreatic cancer. Focusing on early referral to specialist Pancreatic Units might be more effective.
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Surg J R Coll Surg E · Aug 2010
Factors influencing medical students and junior doctors in choosing a career in surgery.
Identification of those factors which influence career choice will help to avoid a shortfall in surgical recruitment. We aimed to determine the views of medical students and junior doctors regarding influences on their career aspirations, such that potential disincentives to a career in surgery could be identified. ⋯ Future employment, career opportunities and intellectual challenge are most important when considering which discipline to choose within medicine, with job prestige of particular importance to those interested in a surgical career. These findings represent an opportunity for surgical educators to reinforce the positive aspects of life as a surgeon, and the job security which is inherent within a surgical career. Surgery remains a disproportionately unpopular choice for women, with lifestyle factors identified as the key deterrent.
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Surg J R Coll Surg E · Aug 2010
ReviewRoutine spinal immobilization in trauma patients: what are the advantages and disadvantages?
Routine spinal immobilization for trauma patients has become established in developed countries throughout the world. Cervical spinal injury is, however, relatively rare in trauma patients, and immobilization practice was developed largely without firm supporting evidence. In recent years, published evidence has suggested that spinal immobilization may in some cases be harmful. ⋯ Relevant results were analysed and critically reviewed in the context of trauma patient management. Our findings present a growing body of evidence documenting the risks and complications of routine spinal immobilization. There is a possibility that immobilization could be contributing to mortality and morbidity in some patients and this warrants further investigation.