Intrathecal analgesia: time to consider it for your patient?

When systemic analgesics or antispasmodics fail to control chronic pain or cause intolerable adverse effects, an intrathecal drug delivery system may be the best bet.

Predicting operative bleeding in elective pediatric surgeries using the Pediatric Bleeding Questionnaire (PBQ).

To test the Pediatric Bleeding Questionnaire's (PBQ) utility for predicting excessive bleeding during elective surgery, we retrospectively evaluated 60 pediatric patients who had been preoperatively investigated for von Willebrand disease. Of 58 patients with bleeding scores (BS) ≤2 (within normal range), 1 hemorrhaged during surgery. Two had a BS of >2 (positive BS); however, neither bled excessively during surgery. The resulting sensitivity, specificity, positive predictive values, and negative predictive values of the PBQ are 0%, 97%, 0%, and 98%, respectively. On the basis of this small sample, we cannot recommend the PBQ for screening in this setting.

Locum tenens consultant doctors in a rural general hospital - an essential part of the medical workforce or an expensive stopgap?

INTRODUCTION: Maintaining hospital consultant staffing levels often requires the employment of locum tenens to meet service needs. This is particularly so in hospitals where core clinical services are run by a small number of permanently appointed consultants. The problems associated with locum employment are underestimated and little attention has been directed towards addressing the issue in the rural general hospitals of Scotland. This study looked at the permanent and short- and long-term locum consultant usage over an 8 year period in one Scottish rural general hospital, the Western Isles Hospital in Stornoway. METHODS: Data were extracted from the Human Resources Department of NHS Western Isles' list of locum consultants for most weeks from the beginning of January 2002 to the end of December 2009. RESULTS: The Western Isles Hospital in Stornoway has an establishment of 17 permanent consultants. During the 8 year study period 239 different consultants were employed, 20 held substantive permanent positions, 31 were long-term locums (employed >3 months) and 188 were short-term locums. The short-term locums worked for 535 different locum episodes. The pattern of usage varied according to service configuration. CONCLUSION: Study data revealed the alarming scope of the locum tenens issue, which will increase unless action is taken. For sustainable medical services to continue in the rural general hospitals of Scotland, staffing models must minimise the need to employ locum consultants.

Surgery in remote and rural Scotland.

Over the past 15 years, rural surgery in Scotland has emerged from the backwaters of the Scottish Health service to a recognized and important part of overall health care provision in Scotland. No longer is the rural surgeon regarded by his city colleague as the eccentric poor relation of the urban specialist. The rural surgeon is now more likely to have the skills and experience necessary for the work that must be done. Training pathways are defined to ensure succession planning. The support of the Scottish Government, Health Boards, and the Royal Colleges has been essential; their continued involvement will ensure safe surgery for those who dwell in the more isolated areas of Scotland.

A critical analysis of orthopedic work load in a teaching hospital in the United Arab Emirates as a stimulus for improving patient care.

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