Measuring serum total cholesterol: do vascular surgeons know what they are doing? (1/160)

Raised serum total cholesterol (TC) is an accepted risk factor for both coronary and peripheral vascular disease and three landmark trials have shown the benefit of lowering TC using statins. Vascular surgeons tend to measure TC, but little is known about how they manage hypercholesterolaemia or whether they believe treatment will be of benefit. A questionnaire was sent to listed members of the Vascular Surgical Society of Great Britain and Ireland seeking responses to a range of questions on the measurement and management of raised TC. In all, 374 questionnaires were sent out. The response rate was 67%. Over 90% of respondents said they measured TC and considered a level below 5.5 mmol/l as normal. The cut-off for initiating drug therapy, referral to a dietician or to a lipid specialist varied from 5.5 to 7.5 mmol/l. Most (62%) believed that lowering TC improved coronary mortality, but fewer (26%) that it prevented worsening of claudication. Although most vascular surgeons check for raised TC, the level at which treatment begins and the form it takes varies; in many cases being at odds with recommendations. Few surgeons are convinced of the benefits of lowering TC for claudication and nearly one-fifth do not believe it improves coronary mortality.  (+info)

Oesophagogastric cancer and surgical subspecialisation: how much work? (2/160)

The aim of this study was to assess the volume of work generated by one consultant (out of a surgical unit of seven) managing all the upper gastrointestinal malignancy in a district general hospital serving a population of 480,000. A 3-year period was prospectively audited and the volume of out-patient and in-patient workload assessed with particular reference to resource management and levels of surgical staffing. Oesophagogastric cancer accounted for a mean of 61 new cases per year, representing 5.3% of new patient referrals. Assuming that a complex major operation for an oesophagogastric cancer equates to four intermediate equivalent values (IEVs), then this translated to a mean operative workload of 186 IEVs per year, representing 16.7% of the total elective operative workload of 1140 IEVs per year. Thus, all the oesophagogastric cancer was managed by a single firm as a speciality in a district general hospital over this 3-year period, though a relatively small proportion of new patients with oesophagogastric cancer translated into a significantly greater burden on the resources of consultant manpower and operating theatre time.  (+info)

Cover arrangements for consultants on leave: an analysis of job descriptions. (3/160)

There is much ambiguity about consultant leave allowances and arrangements for cover in the National Health Service. We analysed job descriptions for 47 consultant posts advertised in mid-2000. 35 defined a duty rota but only 3 mentioned specific available leave (all different). In 32 there was no mention of cover for colleagues on leave. When a consultant is absent, colleagues tend to provide cover for emergency cases but not for elective admissions, which are managed largely by junior doctors. This arrangement is particularly hazardous in surgical specialties. If elective surgery is to continue when the consultant is absent, arrangements for leave and cover need to be more clearly defined.  (+info)

Emergency surgery: atavistic refuge of the general surgeon? (4/160)

A prospective audit of emergency soft-tissue surgery for an eight-week period revealed that general surgical emergency operations were more than twice as common as those undertaken in other soft-tissue specialties. The audit reveals that emergency general surgery needs an increase in resources, an increase in available staff and an increase in the role of the consultant general surgeon on call. An alternative solution would be to admit soft-tissue emergencies by specialty and develop specialist emergency services.  (+info)

An audit of audits: are we completing the cycle? (5/160)

Clinical audit plays an important part in the drive to improve quality of patient care and thus forms a cornerstone of clinical governance. We evaluated the standard of clinical audits conducted by all departments in a teaching hospital between 1996 and 1997. Of a total of 213 audits carried out, 102 (48%) were 'partial' and only 29 (14%) were 'full'. Recommendations for improvement emerged from 134 (63%) of the audits performed. In only 51 audits (24%) was the cycle completed by re-auditing, during the subsequent 3 years. Most departments undertake clinical audits but failure to close the loop undermines their effectiveness and wastes resources.  (+info)

A survey of deep venous thrombosis management by consultant vascular surgeons in the United Kingdom and Ireland. (6/160)

OBJECTIVES: The aim of this study was to detail the current consensus amongst vascular surgeons in Great Britain and Ireland regarding their investigation and management of patients with suspected or proven deep vein thrombosis (DVT). METHODS: The database of the Vascular Surgical Society of Great Britain and Ireland (VSS) was utilised to send coded postal questionnaires to all consultant surgeon members. RESULTS: Replies were received from 281 (65%) consultants. Duplex ultrasound is used alone to confirm DVT by 69% of respondents. A thrombophilia screen is always performed by 14% of consultants, for patients with proven DVT, and is more commonly requested by consultants based in a teaching hospital. The majority (57%) of consultants treat DVT with unfractionated heparin (UFH) and warfarin, whereas only 38% utilise low molecular weight heparins (LMWH) and warfarin. A management policy for DVT is reported to be in place by 59%, and a set policy for the specific management of calf vein DVT by just 20%. CONCLUSION: New diagnostic modalities and treatments have been developed for DVT that are more convenient and cost-effective. Although clinical guidelines for the management of patients with DVT are beginning to emerge, there is still a wide discrepancy in many areas of DVT management, and practice at variance with the current evidence base, amongst vascular surgeons in the United Kingdom and Ireland.  (+info)

Groin hernia surgery: a systematic review. (7/160)

BACKGROUND: An extensive volume of clinical research has been undertaken on the use of surgery for groin hernias. For many years there has been a large number of different methods of repairing hernias and, with the introduction of laparoscopic surgery, this has increased further. It is uncertain which method is the best in terms of safety and effectiveness. OBJECTIVES: This review was undertaken to compare the outcomes following different surgical procedures to treat groin hernias in adults. It sought answers to six questions: 1)Which method of surgery (including open procedures and laparoscopic surgery) is the safest and most effective for inguinal hernia repair? 2) Is local anaesthesia a safe and effective alternative to general anaesthesia? 3) Is there a difference in outcome between specialist and non-specialist surgeons? 4) Is day-case as safe and effective as inpatient surgery? 5) Is synchronous bilateral hernia repair as safe and effective as delayed repair? 6) Which method of surgery is the safest and most effective for femoral hernia repair? METHODS: The primary measure of effectiveness used was the proportion of hernia repairs in which there was a recurrence. Secondary outcome measures included complications, post-operative pain, wound infection, time to return to normal activities and/or return to work. A systematic search of the literature (up to February 1996) was undertaken using a variety of approaches. the methodological quality of all prospective comparative studies (45 randomised trials and 26 non-randomised trials/prospective cohort studies) was assessed using a standard checklist. RESULTS: Some of the variation in findings from different studies is likely to be due to methodological differences rather than differences in the effectiveness of the surgical procedures. The main methodological shortcomings of the studies that have been performed are: lack of agreed method for assessing severity of hernias; failure to take confounding into account in non-randomised studies; variation in length of follow-up; poor external validity; lack of objective measures of outcome; and inadequate statistical power. These problems severely limit the conclusions that can be drawn from the literature.  (+info)

Mismatch between general surgical trainees' sub-specialist interests and advertised jobs: a cause for concern? (8/160)

The main aim of this study was to establish the primary sub-specialist interest of a group of senior general surgical trainees and compare these results with the required sub-specialist interests in consultant vacancies advertised in the British Medical Journal between 3.1.98 and 25.12.99. Colorectal surgery was the most popular sub-specialty amongst trainees (29.4%) followed by upper gastrointestinal/hepato-pancreato-biliary (UGI/HPB) (27.2%) and vascular surgery (24.3%). The least popular sub-specialties were breast/endocrine (11.4%) and transplant (2.9%). A total of 324 consultant jobs were advertised, with the sub-specialist interest required as follows: Colorectal (25.6%), breast/endocrine (23.5%), vascular (20.4%), UGI/HPB (12%) and transplant (5.6%). Although this study only covers a two-year period, there are obvious discrepancies between trainees' sub-specialist interests and consultant vacancies. Whilst the jobs to trainees ratios are well matched in colorectal and vascular surgery, it appears that there are not enough transplant or breast trainees and too many UGI/HPB trainees for the number of jobs available. This problem needs urgent attention to avoid service shortfalls in unpopular sub-specialties and to avoid training people for jobs that do not exist.  (+info)