Identifying avoidable switchboard delays in England's NHS hospitals: phase one of the national SWITCH project.

Background: Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care.

Methods: All 175 acute hospital switchboards in England were contacted six times.

Beating heart against cardioplegic arrest studies (BHACAS 1 and 2): quality of life at mid-term follow-up in two randomised controlled trials.

Aims: Off-pump coronary bypass grafting (OPCAB) has short-term benefits compared to conventional bypass grafting using the heart-lung machine (CABG-CPB) but may compromise longer term outcome. We aimed to compare generic and disease specific quality of life (QoL) two to four years after surgery in participants in two randomised controlled trials of OPCAB vs. CABG-CPB.

A multi-centre randomised controlled trial of minimally invasive direct coronary bypass grafting versus percutaneous transluminal coronary angioplasty with stenting for proximal stenosis of the left anterior descending coronary artery.

Objectives: To compare the clinical- and cost-effectiveness of minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous transluminal coronary angioplasty (PTCA) with or without stenting in patients with single-vessel disease of the left anterior descending coronary artery (LAD).

Design: Multi-centre randomised trial without blinding. The computer-generated sequence of randomised assignments was stratified by centre, allocated participants in blocks and was concealed using a centralised telephone facility.

Transanal endoscopic microsurgery.

The anatomy of the pelvis makes it difficult to perform local excisions in the rectum when a tumour is some distance from the anal verge. Transanal endoscopic microsurgery, a minimally invasive procedure, has been developed. It provides an alternative to the transsacral or transabdominal approach, with subsequent shorter hospital stay and fewer complications.

Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity.

Thiamine deficiency is known to lead to certain neurological sequelae including Wernicke- Korsakoff encephalopathy. Signs attributable to this condition include ataxia, ophthalmoplegia, nystagmus, and mental confusion. Recognised predisposing conditions include alcoholism gastric carcinoma, pyloric obstruction, hyperemesis gravidarum, and prolonged intravenous feeding.

Quest for continence: surgery for ulcerative colitis and familial adenomatous polyposis.

In the past decade pelvic pouch procedure (restorative proctocolectomy) has become the surgical treatment of choice for ulcerative colitis and most cases of familial adenomatous polyposis. It is an operation that eradicates disease yet restores gastrointestinal continuity and maintains continence.