Scot Med J
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A postal survey of all senior anaesthetists with routine commitment to an acute trauma list in 13 Scottish hospitals was conducted to delineate contemporary anaesthetic practice for hip fracture surgery. Almost equal use of general and regional anaesthesia was reported, however the techniques used for general anaesthesia were different from those described in previous literature in this group. ⋯ However these conclusions relate to techniques and drugs which are now rarely used during general anaesthesia for hip fracture surgery. Further work to assess the impact of new techniques and agents on outcome for this group of patients may be required.
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Fingertip and nailbed trauma caused by doors is common in children, occurring when fingers are either shut in the door itself or are trapped in the hinge as the door is closed. An audit was carried out over five months of all fingertip and nailbed injuries due to trauma from a door. One hundred and eighty eight children, 2% of all attendances in this period, had sustained such trauma, 39% of these occurring in children under four years of age. ⋯ Avulsion of the nail from the nailbed or amputation of part of the fingertip and 29 (15%) of all the cases required a general anaesthetic for exploration, cleaning and repair. The Plastic Surgery department followed up these 29 children and 71 Accident & Emergency follow-up appointments were generated by the remaining injuries. The incidence of significant injury was higher than expected and caused considerable distress to both the children and their parents, It is suggested that home safety protocols should feature advice on how to avoid these injuries.
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In a previous paper on mortality audit we reported on the use of treatment limiting decisions (TLDs) in a neurosurgical unit in the year 1988. In this paper we compare the findings of a similar audit for 1997. It appears that our unit's policy of openly discussing all TLDs in patients who die had led to such decisions being made at a more appropriate stage in the patient's illness. Regular review of TLDs is probably helpful in increasing the confidence of clinicians to make these difficult decisions openly and timeously.
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The poppy, the cinchona tree and the willow tree have all provided medicines of undoubted value during past millennium and form a "medical bouquet" worthy of consideration as this century ends. The use of these plants by ancient peoples has gradually evolved into a more informed understanding and application of the compounds initially isolated and purified from their extracts. There has been a Scottish contribution to the medical history of all three plants.