Discrete-choice preference comparison between patients and doctors for the surgical management of oesophagogastric cancer (Br J Surg DOI: 10.1002/bjs.7537).
Effect of injury on S1 dorsal root ganglia in an experimental model of neuropathic faecal incontinence (Br J Surg 2011; 98: 1155-1159) and Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model (Br J Surg 2011; 98: 1160-1169).
Authors: McSwain N, Rotondo M, Meade P, Duchesne J
Abstract
BACKGROUND: In the United States and many other countries, there has been limited attempt to develop a trauma system that addresses the unique trauma situations that occur in rural areas. Rather the planners have attempted to simply extend the urban based trauma system into rural communities. This extension does not address the needs of the majority of patients who are injured in rural communities.
METHODS: A review of the types of patients seen in the rural communities, the volume of these patients and the destination protocols used in the rural communities as taught by the ACS/ATLS and the implications of the CDC Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage were reviewed, assessed and compared to the needs in the rural areas for a rural trauma system. In addition, a quality assessment tool was used from a major trauma centre whereby the frequency of patients transported to the centre that were inappropriate for the trauma centre was indicated by the volume that were discharged in 6 h.
RESULTS: Most of the patients injured in the rural communities can be treated in the critical access and rural hospital (> 90 per cent) and can be provided with good care without the need for emergency medical service (EMS) transportation long distances to the trauma centre, inappropriate use of air EMS vehicles thus circumventing families having to travel long distances to see patients, incurring expense and inconvenience, and avoiding loss of revenue to the local hospitals and the overload of urban trauma centres. Rather triage criteria can be taught as per the EMS systems, training given to rural hospital personnel, hospital administrators instructed as to the benefit of such a system, citizens educated as to the advantage of keeping their loved ones closer to home and trauma system registries used to enhance the correct use of the trauma system.
Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients (Br J Surg 2012; 99: 336-344).
