Surg J R Coll Surg E
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Surg J R Coll Surg E · Apr 2009
The necessity of routine post-thoracostomy tube chest radiographs in post-operative thoracic surgery patients.
Chest radiographs are routinely performed post-operatively in thoracic surgery patients, in particular after the removal of thoracostomy tubes. From observation of our practice, we hypothesised that chest radiographs did not need to be performed routinely post-operatively and after removal of thoracostomy tubes. ⋯ We feel our data support the hypothesis that it is not necessary to perform routine chest radiographs in thoracic surgery patients post-operatively and after post-operative thoracostomy tube removal. It would be better to monitor these patients clinically and only request chest radiographs on the basis of deterioration in recorded observations or clinical findings.
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Surg J R Coll Surg E · Apr 2009
The impact of pre-operative assessment clinics on elective surgical case cancellations.
Pre-operative assessment clinics prepare patients for elective procedures. Little is known about their impact on elective case cancellations. We investigated whether a pre-operative assessment clinic would reduce surgical case cancellations. ⋯ When we analysed the data in terms of the reason for cancellation, we found that cancellations for medical, but not patient reasons were significantly reduced following pre-assessment (p = 0.013 and p = 0.180, respectively). The data suggest that establishment ofa pre-operative assessment clinic reduces elective case cancellations. In particular we found a significant reduction in cancellations for medical reasons.
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Surg J R Coll Surg E · Feb 2009
Northern Ireland General Surgery Handover Study: surgical trainees' assessment of current practice.
Effective handover of clinical information between work shifts is essential for patient safety. We aimed to identify current practice and trainees' assessment of handover in the general surgical departments of Northern Ireland (NI). ⋯ General surgical trainees in NI have expressed concern regarding current practices of patient handover between shifts. Those working under the 'surgeon of the week' emergency system are more satisfied and deem it significantly safer.
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Neurosurgery has primarily been concerned with resective or ablative techniques for the accurate removal of pathological tissue with the minimal disruption of surrounding healthy neuronal matter. There have been numerous advances in neurosurgery which have aided the neurosurgeon to achieve this aim including the development of microsurgical, endoscopic and endovascular techniques. Functional neurosurgery has also seen a particular resurgence over the last 15 years with the identification of new anatomical targets and clinical indications. ⋯ Accurate epilepsy surgery requires imaging of the epileptogenic zone and accurate identification of adjacent eloquent cortex. New imaging modalities such as PET, SPECT, and fMRI can now be used in order to reduce neurological deficits resulting from surgery. This review highlights some of the major advances in neurosurgery and discusses the impact of neuronavigation and functional imaging in tumour surgery and epilepsy surgery.
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Surg J R Coll Surg E · Oct 2008
Unnecessary investigations in patients with acute pancreatitis: arterial blood sampling and serum biochemistry.
Most patients admitted with acute pancreatitis undergo arterial blood gas sampling (ABG) to calculate the modified Glasgow score (MGS) and serum amylase and liver function tests (LFTs) are requested frequently during admission. This study aims to assess the necessity of these investigations. ⋯ We propose not performing ABGs if the MCS excluding the PaO2 component totals two or less. Clinical judgment would have to be exercised. Unnecessary serum biochemistry requests are frequent but at little financial expense.