ABSTRACT
BACKGROUND: There has been a plethora of new job titles emerging in the NHS. While the term 'nurse practitioner' was fairly well received, and offers a pretty clear indication of the background of the person working, other new titles can be misleading. Since 2003, when the NHS Modernisation Agency proposed its 'Changing Workforce Programme', nurses and other allied health professionals were recruited and trained to perform 'simple operations'. The surgical care practitioner is being developed along with other practitioners. OBJECTIVE: To find out whether patients are able to identify healthcare professionals by their title and what do patients think about a non-medically qualified person carrying out their operations. METHODS: A cross-sectional survey of ENT patients using a questionnaire. MAIN FINDINGS: Titles similar to those of medically qualified professionals--anaesthetic practitioner, consultant nurse and surgical care practitioners--can lead patients to think that they are doctors. Fifty-three per cent of the respondents agreed that not all hospital visits need to be attended by a doctor, but if an operation is needed, 92% of respondents thought it should be carried out by someone who is medically trained. Ninety-four per cent stated that they should be informed if this is not the case. Seventy-nine per cent of the respondents stated that they would rather wait longer to be operated on by a doctor than being operated on earlier by someone who is not medically qualified but trained to perform the operation only. This result is significant, p<0.001). CONCLUSION: Patients do find the different titles confusing, with many preferring a more transparent approach in knowing who their surgeon is. The majority would prefer to wait longer for their operation if this means it is carried out by a doctor.
Subject(s)
Clinical Competence , General Surgery/standards , Physician Assistants , Terminology as Topic , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Patient Care Team/standards , Patient Satisfaction , Physician Assistants/standards , Physician Assistants/statistics & numerical data , State Medicine/organization & administration , State Medicine/standards , United Kingdom , Young AdultSubject(s)
Anesthetics, Local/administration & dosage , Cocaine/administration & dosage , Endoscopy , Epinephrine/administration & dosage , Paranasal Sinus Diseases/surgery , Sodium Bicarbonate/administration & dosage , Administration, Intranasal , Administration, Topical , Equipment Design , Humans , Pain, Postoperative/prevention & control , SolutionsABSTRACT
BACKGROUND: Pain relief after tonsillectomy is an important part of post-operative management. Sometimes local anaesthetics are administed to the tonsillar region, but their effectiveness in relieving pain has not been formally assessed. OBJECTIVES: To assess the effects of pre- and post-operative local anaesthesia for pain reduction following tonsillectomy. SEARCH STRATEGY: Cochrane Controlled Trials Register, Medline, Embase and the Oxford Pain Database. Reference lists from identified publications, including those in non-English language publications, were scanned. Date of the most recent search was September 1998. SELECTION CRITERIA: Randomised controlled trials of adults and/or children undergoing tonsillectomy alone with local anaesthetic (a) injected into the tonsillar region immediately prior to removal of the tonsils (b) injected into the tonsillar region after removal of the tonsils (c) sprayed or otherwise applied to the tonsillar region after removal of the tonsils Outcome measures included the reduction in demand for post-operative analgesia, both in terms of time elapsed to request for first analgesia and of the total amount of analgesia used. DATA COLLECTION AND ANALYSIS: All three reviewers extracted data independently and assessed trials for quality. Four authors were contacted to obtain information on either the method of randomisation or the type of intervention used. MAIN RESULTS: Thirty trials were initially identified but only six trials met the inclusion criteria. These were all published in the English language literature between 1989 and 1997. Trials were excluded because procedures in addition to tonsillectomy were undertaken, inadequate randomisation techniques were used or because group sizes were inadequate. Of the six included studies, five involved local anaesthetic injection and one application of local anaesthetic spray. These studies used validated pain scores and measurement of supplemental analgesic intake for assessment of pain. However, some studies also included inappropriate, possibly post-hoc, outcome measures such as 'global pain scores' which may have resulted in bias. No included study showed a significant difference between intervention and control, other than for outcome measures which were felt to be inappropriate, such as the one mentioned above. REVIEWER'S CONCLUSIONS: There is no evidence that the use of perioperative local anaesthetic in patients undergoing tonsillectomy improves post-operative pain control. The trials identified were of small size and several involved the perioperative co-administration of intravenous opiates which may have masked any beneficial effect of the local anaesthetic. Further randomised controlled trials are necessary.
Subject(s)
Anesthesia, Local , Pain, Postoperative/prevention & control , Tonsillectomy , HumansABSTRACT
Benign tumours of both the pharynx and oesophagus are rarely seen, cavernous haemangiomas even less so. We present a case in which a large lesion was the cause of non-specific symptoms but which only appeared intermittently on nasendoscopic examination of the pharynx.
Subject(s)
Esophageal Neoplasms/diagnosis , Hemangioma, Cavernous/diagnosis , Pharyngeal Neoplasms/diagnosis , Aged , Biopsy , Cough/etiology , Cough/surgery , Endocarditis, Bacterial/etiology , Esophageal Neoplasms/surgery , Female , Hemangioma, Cavernous/surgery , Humans , Laryngoscopy , Mitral Valve , Pharyngeal Neoplasms/surgery , Postoperative Complications/etiology , ReflexABSTRACT
Recurrent epistaxes after head injury may rarely be due to a traumatic intracavernous carotid artery pseudoaneurysm. The head injury is usually associated with fracture of the skull base and the epistaxes are severe with the first episode generally occurring one to three months after the initial trauma. We present a case which illustrates the role of high resolution computed tomography (CT) scanning and also magnetic resonance angiography (MRA) in achieving the diagnosis.
Subject(s)
Aneurysm, False/complications , Carotid Artery Injuries , Craniocerebral Trauma/complications , Epistaxis/etiology , Adult , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Carotid Artery, Internal/surgery , Craniocerebral Trauma/diagnostic imaging , Craniocerebral Trauma/surgery , Epistaxis/diagnostic imaging , Epistaxis/surgery , Humans , Ligation , Magnetic Resonance Angiography , Male , Syndrome , Time Factors , Tomography, X-Ray Computed , Vision, MonocularABSTRACT
Seven of the most commonly used tracheostomy tubes used in the UK were tested for cuff herniation and creasing in synthetic tracheas corresponding to the shapes and sizes found in vivo. Results demonstrated that only two tubes of one particular brand herniated and that creasing occurred in tubes disproportionately large for the trachea used. A discussion of modern tracheostomy tube manufacture is included.
Subject(s)
Tracheostomy/instrumentation , Equipment Failure , Evaluation Studies as Topic , HumansABSTRACT
Masseter muscle enlargement is one of the differential diagnoses of swelling of the cheek. We discuss a unique case of a malignant tumour of the masseter which was found to be a peripheral primitive neuroectodermal tumour (PNET). A review of tumours of the masseter is presented.
Subject(s)
Facial Neoplasms/pathology , Masseter Muscle , Muscle Neoplasms/pathology , Neuroectodermal Tumors/pathology , Adult , Female , HumansABSTRACT
Estimation of nasal airflow, flow asymmetry and nasal valve stiffness was performed using anterior rhinomanometry in a group of 12 normal subjects and a group of 12 patients suffering from nasal obstruction. The method, based upon a simplified mathematical model of nasal airflow and utilizing logarithmic transformation of inspiratory pressure and flow data, improved the sensitivity and specificity of rhinomanometry and gave a more comprehensive index of nasal function.
Subject(s)
Airway Resistance/physiology , Nasal Obstruction/diagnosis , Pulmonary Ventilation/physiology , Case-Control Studies , Female , Humans , Male , Manometry/methods , Models, Theoretical , Nasal Obstruction/physiopathology , Sensitivity and SpecificityABSTRACT
Antral puncture and lavage through the inferior meatus is a minor but common otolaryngological procedure, usually performed under local anaesthesia. We describe a new method of introducing local anaesthetic into the inferior meatus, via the use of a soft intravenous cannula connected to a syringe containing 10 per cent cocaine paste. We have called this new technique inferior meatal cannula anaesthesia (IMCA).
Subject(s)
Anesthesia, Local/methods , Cocaine , Maxillary Sinusitis/therapy , Therapeutic Irrigation , Anesthesia, Local/instrumentation , Catheterization , Humans , Maxillary SinusABSTRACT
Laryngeal chondroradionecrosis is an unusual condition which may present many years after the initial radiotherapy. We present a case of late onset chondroradionecrosis which was complicated by invasive candidiasis of the arytenoid cartilages which had themselves been extruded through the laryngeal mucosa.
Subject(s)
Candidiasis/complications , Laryngeal Cartilages/microbiology , Radiotherapy/adverse effects , Adult , Candidiasis/pathology , Candidiasis/surgery , Carcinoma, Squamous Cell/radiotherapy , Female , Glottis/diagnostic imaging , Humans , Laryngeal Cartilages/pathology , Laryngeal Cartilages/surgery , Laryngeal Neoplasms/radiotherapy , Necrosis , Radiography , Time FactorsABSTRACT
Wegener's granulomatosis is a multi-system disease characterized by granuloma formation and a necrotizing vasculitis. It classically presents with involvement of the upper and lower respiratory and renal systems. However locoregional disease is common and may include otological manifestations. Facial nerve palsy has been reported during the course of the disease process but it is extremely rare for it to be the presenting feature. Previously reported cases have involved a protracted diagnostic process including exploratory tympanotomy, mastoidectomy and facial nerve decompression. We report a case of Wegener's granulomatosis which presented with a facial nerve palsy. An early diagnosis was achieved by measurement of the erythrocyte sedimentation rate (ESR), followed by serological assay of cytoplasmic anti-neutrophil cytoplasmic antibody (cANCA). Histological examination of nasal mucosal biopsies confirmed granuloma formation consistent with a diagnosis of Wegener's granulomatosis. This allowed early treatment with immunosuppressive therapy and avoided unnecessary and potentially hazardous middle ear surgery.
Subject(s)
Facial Paralysis/etiology , Granulomatosis with Polyangiitis/complications , Aged , Antibodies, Antineutrophil Cytoplasmic , Autoantibodies/blood , Blood Sedimentation , Facial Paralysis/pathology , Female , Granulomatosis with Polyangiitis/blood , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/pathology , Humans , Nasal Mucosa/pathology , Tomography, X-Ray ComputedABSTRACT
An important part of the initial assessment of children presenting with congenital nasal masses is to exclude an intracranial extension using either magnetic resonance imaging (MRI) or computed tomography (CT) imaging. We present three patients with such lesions in which unusual radiological findings were noted as part of the investigations.
Subject(s)
Lipoma/pathology , Nose Neoplasms/pathology , Female , Gingival Neoplasms/pathology , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
Pharyngeal perforation is an uncommon injury in children. Most reported cases to date have been secondary to instrumentation or penetrating wounds. Laceration to the pharyngeal wall may introduce air, secretions and bacteria into the parapharyngeal space and mediastinum and consequently has potentially life-threatening sequelae. The management of these injuries is controversial. We present a series of four children who suffered pharyngeal trauma, accidentally and otherwise, and discuss their management. We recommend a high index of suspicion of pharyngeal injury in all cases of oropharyngeal trauma and overnight admission to hospital for observation until an accurate diagnosis has been established. Non-accidental injury of the child must be seriously considered in all cases.
Subject(s)
Accidents , Child Abuse/diagnosis , Pharynx/injuries , Child , Endoscopy , Female , Humans , Infant , Male , Wounds and Injuries/diagnosis , Wounds and Injuries/etiologyABSTRACT
Internal carotid artery trauma is a rare but potentially disastrous complication of surgery to the sphenoid sinus and pituitary gland. Emergency and elective procedures to establish haemostasis are discussed.