Role of the accident and emergency review clinic in UK service provision.

OBJECTIVES: Selected patients attending accident and emergency (A&E) are seen again in the A&E review clinic for planned follow up. Despite the large number of patients being seen in these clinics, this area of A&E service provision has rarely been studied. The aim of this study was to determine the current provision of review clinic services in UK A&E departments, their organisation, and their perceived role in current practice. METHODS: Postal survey of all major UK adult and paediatric A&E units. RESULTS: Almost all major UK A&E departments have a review clinic service and almost three quarters see less than 10% as reviews in line with current guidance. Many departments feel their clinics are well run and fulfil their objectives. Others are under pressure from external sources to see more patients. Over a third of departments have no written policies or protocols guiding referral to these clinics. CONCLUSION: Review clinics are an important part of the A&E service in the UK and minimum standards need to be set in the provision of these services. Further audit and research needs to be carried out on the review clinic service to guide its future development.

Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring.

The aim of this study was to retrospectively survey patients who had undergone the uvulopalatopharyngoplasty (UPPP) operation over a two-year period, assessing loudness of snoring, sleep quality and patient satisfaction. A total of 271 patients were sent questionnaires to assess snoring and sleeping habits, with additional questions about pain and satisfaction with surgery. Those who did not reply were contacted by telephone. Seventy-four per cent of the target population were surveyed. Taking an improvement in snoring level of 50 per cent or greater, immediately post-operatively the overall success rate was 76 per cent; however, after two years the success rate fell to 45 per cent. Variables such as alcohol consumption and smoking were not found to influence results. On a post-operative pain scale of 1-10 the average was 7.5 and on a satisfaction scale of 1-10 the average satisfaction with surgery was five, 61 per cent of patients stating that they would not have this operation again. This study shows that the UPPP operation is successful in only 45 per cent of patients after long-term follow-up, that the majority of patients experience severe pain and that the overall satisfaction with surgery is low.

Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic.

BACKGROUND: Pruritus ani is a common and socially embarrassing condition which is often poorly managed. It is often classified as idiopathic where the symptoms are usually transitory or secondary when a more persistent itch is experienced. The aim of this study was to establish the cause of pruritus ani in a group of patients referred to a combined colorectal and dermatological clinic, and to determine the most appropriate treatment. METHODS: Forty consecutive patients with pruritus ani were referred over a 6-month period from either the general practitioner or another hospital consultant to a combined colorectal and dermatological clinic. They were assessed by history, completion of a general health questionnaire, full examination of the skin, digital rectal examination, proctoscopy, sigmoidoscopy and patch testing. Patients were treated according to clinical findings at assessment. RESULTS: Thirty-four patients had a recognizable dermatosis, three had superficial perianal fissuring and three had a normal perineum; two required surgical intervention. Eighteen patients had a positive reaction when patch tested. All patients have shown an improvement or complete resolution of symptoms with treatment. CONCLUSION: This series has shown that the majority of patients presenting with pruritus ani have a dermatosis as the underlying cause of their symptoms and that many of them have developed contact sensitivities to the various topical medications used. These findings suggest that referral to a dermatologist in the first instance may be more appropriate.