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1.  Can guidelines improve referral to elective surgical specialties for adults? A systematic review 
Quality & Safety in Health Care  2010;19(3):187-194.
Aim
To assess effectiveness of guidelines for referral for elective surgical assessment.
Method
Systematic review with descriptive synthesis.
Data sources
Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites.
Selection of studies
Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults.
Outcome measures
Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs.
Results
24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change.
Conclusions
Guidelines for elective surgical referral can improve appropriateness of care by improving pre-referral investigation and treatment, but there is no strong evidence in favour of other beneficial effects.
doi:10.1136/qshc.2008.029918
PMCID: PMC2989157  PMID: 20211956
Family practice (MeSH); primary healthcare (MeSH); referral and consultation (MeSH) surgical procedures; operative (MeSH); practice guidelines (MeSH); algorithms (MeSH]
2.  Dynamic Data-Driven Finite Element Models for Laser Treatment of Cancer 
Elevating the temperature of cancerous cells is known to increase their susceptibility to subsequent radiation or chemotherapy treatments, and in the case in which a tumor exists as a well-defined region, higher intensity heat sources may be used to ablate the tissue. These facts are the basis for hyperthermia based cancer treatments. Of the many available modalities for delivering the heat source, the application of a laser heat source under the guidance of real-time treatment data has the potential to provide unprecedented control over the outcome of the treatment process [7, 18]. The goals of this work are to provide a precise mathematical framework for the real-time finite element solution of the problems of calibration, optimal heat source control, and goal-oriented error estimation applied to the equations of bioheat transfer and demonstrate that current finite element technology, parallel computer architecture, data transfer infrastructure, and thermal imaging modalities are capable of inducing a precise computer controlled temperature field within the biological domain.
doi:10.1002/num.20251
PMCID: PMC2850081  PMID: 20376194
hyperthermia; real-time computing; medical imaging; cancer treatment; optimization; goal-oriented error estimation
3.  Factors associated with the health status of internally displaced persons in northern Uganda 
Background:
Globally, there are over 24 million internally displaced persons (IDPs) who have fled their homes due to violence and insecurity but who remain within their own country. There have been up to 2 million IDPs in northern Uganda alone. The objective of this study was to investigate factors associated with mental and physical health status of IDPs in northern Uganda.
Methods:
A cross-sectional survey was conducted in November 2006 in IDP camps in the Gulu and Amuru districts of northern Uganda. The study outcome of physical and mental health was measured using the SF-8 instrument, which produces physical (PCS) and mental (MCS) component summary measures. Independent demographic, socio-economic, and trauma exposure (using the Harvard Trauma Questionnaire) variables were also measured. Multivariate regression linear regression analysis was conducted to investigate associations of the independent variables on the PCS and MCS outcomes.
Results:
1206 interviews were completed. The respective mean PCS and MCS scores were 42.2 (95% CI 41.32 to 43.10) and 39.3 (95% CI 38.42 to 40.13), well below the instrument norm of 50, indicating poor health. Variables with negative associations with physical or mental health included gender, age, marital status, income, distance of camp from home areas, food security, soap availability, and sense of safety in the camp. A number of individual trauma variables and the frequency of trauma exposure also had negative associations with physical and mental health.
Conclusions:
This study provides evidence on the impact on health of deprivation of basic goods and services, traumatic events, and fear and uncertainty amongst displaced and crisis affected populations.
doi:10.1136/jech.2008.076356
PMCID: PMC2635937  PMID: 19028730
4.  A meta-analysis of variables that predict significant intracranial injury in minor head trauma 
Archives of Disease in Childhood  2004;89(7):653-659.
Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury.
Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population.
Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. Outcome variable: CT presence or absence of ICH.
Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0).
Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.
doi:10.1136/adc.2003.027722
PMCID: PMC1719991  PMID: 15210499
5.  High Quality Acute Care for the Severely Injured is not Consistently Available in England, Wales and Northern Ireland: Report of a Survey by the Trauma Committee, The Royal College of Surgeons of England 
INTRODUCTION
A survey was undertaken to determine the extent to which acute hospitals in England, Wales and Northern Ireland were meeting the acute trauma management standards published in 2000 by The Royal College of Surgeons of England and the British Orthopaedic Association.
METHODS
A questionnaire comprising 72 questions in 16 categories of management was distributed in July 2003 to all eligible hospitals via the link network of the British Orthopaedic Association. Data were collected over a 3-month period.
RESULTS
Of 213 eligible hospitals, 161 (76%) responded. In every category of acute care, failure to meet the standards was reported. Only 34 (21%) hospitals met all the 13 indicative standards that were considered pivotal to good trauma care, but all hospitals met at least 7 of these standards. Failures were usually in the organisation of services rather than a lack of resources, with the exception of the inadequate capacity for admission to specialist neurosurgery units. A minority of hospitals reported an inability to provide emergency airway control or insertion of chest tube. The data have not been verified and deficiencies in reporting cannot be excluded.
CONCLUSIONS
The findings of this survey suggest that high quality care for the severely injured is not available consistently across England, Wales and Northern Ireland, and appear to justify concerns about the ability of the NHS to deal effectively with the current trauma workload and the consequences of a major incident.
doi:10.1308/003588406X94850
PMCID: PMC1964077  PMID: 16551394
Trauma; Severe injury; Acute care; Survey
6.  The experience and training of British general surgeons in trauma surgery for the abdomen, thorax and major vessels. 
BACKGROUND: The report Better Carefor the Severely Injured [London: The Royal College of Surgeons of England and the British Orthopaedic Association; 2000] states that an experienced general surgeon trained in the techniques required to perform life-saving emergency surgery is vital in the management of major trauma. The experience and training of general surgeons in the UK in the management of trauma to the abdomen, thorax and major vessels has never been assessed. METHOD: Postal questionnaire sent to UK general surgical consultants and Higher Surgical Trainees (HSTs). RESULTS: A total of 854 (48%) questionnaires were completed. Of respondents, 85% believe that major trauma should be directed to hospitals that provide a dedicated trauma service. Of non-vascular specialists, 43% felt their training was adequate to manage vascular trauma and only one-third of general surgical consultants felt adequately prepared to manage acute cardiothoracic injuries. The median number of trauma laparotomies undertaken annually was 2 for blunt injury and 1 for penetrating injury. Of HSTs, 21% had not performed a splenectomy for trauma and 44% had no experience of packing for liver injuries. CONCLUSIONS: There is limited experience and training in the surgical management of torso trauma in the UK. Implementation of the recommendations from Better Care for the Severely Injured will be hampered unless steps are taken to maximise experience and improve training.
doi:10.1308/003588402760978210
PMCID: PMC2504212  PMID: 12484581
7.  Darbepoetin alfa is more potent in vivo and can be administered less frequently than rHuEPO 
British Journal of Cancer  2002;87(4):476-477.
doi:10.1038/sj.bjc.6600506 www.bjcancer.com
© (2002) Cancer Research UK
doi:10.1038/sj.bjc.6600506
PMCID: PMC2376125
8.  Lateral Orbital/Anterior Midfacial Degloving Approach for Nasopharyngeal Angiofibromas with Cavernous Sinus Extension 
Skull base surgery  1994;4(4):232-238.
A case of nasopharyngeal angiofibroma removed through a modified lateral approach for an infratemporal fossa resection is reported. This modification involved removing the bone of the lateral orbital apex and posterior middle fossa to expose the dura and periorbita and, when combined with a midfacial degloving approach, provided full access to the tumor abutting the cavernous sinus extradurally while preserving middle ear function.
Images
PMCID: PMC1661816  PMID: 17171177
9.  Surgical Therapy of Glomus Vagale Tumors 
Skull base surgery  1993;3(4):182-192.
Lying between the carotid bifurcation and the jugular foramen, glomus vagale tumors share characteristics with paragangliomas of those two structures, such as invasion of the carotid artery, destruction of the skull base, and cranial neuropathies. This capability for local invasion provides a therapeutic challenge with regard to the proper assessment of tumor extent and the selection of appropriate treatment. In order to clarify an approach to the management of glomus vagale tumors, we reviewed a 10-year experience with 15 patients treated for this tumor at the University of Zürich Department of Otolaryngology, using a new system of classification. This system highlights the relative position of a vagal paraganglioma to the jugular foramen and is helpful in designing the proper therapy. Pitfalis in surgical technique, recommended preoperative evaluation, and the roles of balloon occlusion and irradiation in the treatment of these tumors, are discussed.
Images
PMCID: PMC1656457  PMID: 17170910
10.  Spas and sensibilities: Darwin at Malvern. 
Images
PMCID: PMC2557456  PMID: 11622586
11.  Vaginal Cytology 
British Medical Journal  1974;1(5904):391.
PMCID: PMC1633628
14.  Practicalities of nursing. 
British Medical Journal  1971;3(5776):702.
PMCID: PMC1798999  PMID: 5569555
16.  Operative Gynaecology 
British Medical Journal  1969;1(5636):103-104.
PMCID: PMC1981949
18.  Placental Insufficiency 
Postgraduate Medical Journal  1962;38(438):225-228.
PMCID: PMC2482454  PMID: 13873750
19.  Jargon 
British Medical Journal  1964;1(5383):632.
PMCID: PMC1813912
20.  Jargon 
British Medical Journal  1964;1(5377):245.
PMCID: PMC1813068
23.  Clinical Aspects of Prolonged Pregnancy 
British Medical Journal  1962;2(5312):1080-1081.
PMCID: PMC1926448  PMID: 14016070

Results 1-25 (67)