Accuracy of clinician-clinical coder information handover following acute medical admissions: implication for using administrative datasets in clinical outcomes management.

Background: We evaluated the accuracy, limitations and potential sources of improvement in the clinical utility of the administrative dataset for acute medicine admissions.

Methods: Accuracy of clinical coding in 8888 patient discharges following an emergency medical hospital admission to a teaching hospital and a district hospital over 3 years was ascertained by a coding accuracy audit team in respect of the primary and secondary diagnoses, morbidities and financial variance.

Results: There was at least one change to the original coding in 4889 admissions (55%) and to the primary diagnosis of at least one finished consultant episodes of 1496 spells (16.

Further anatomical approaches to parotid surgery.

The rhytidectomy incision has recently been used to approach the parotid gland and has gained increasing popularity, particularly amongst facial-plastic surgeons. However, as the skin incision is placed further back with this approach than with the traditional incision, many surgeons remain concerned with reference to the adequacy of exposure. We report a further anatomical study to compare the surgical access provided by the two incisions that helps address these concerns.

The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study.

Background: The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; hence anatomical landmarks and adequate operative exposure can aid such identification and preservation. In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically.

Methods: The clinical component of the study included prospective reviewing of 100 consecutive routine parotidectomies; while, the anatomical component of the study involved dissecting 50 cadaveric hemifaces.

How we do it: a method of neck dissection for histopathological analysis.

Background: Dissection of the lymphatic structures in the neck is an integral part of the management of many head and neck cancers. We describe a technique of surgical dissection, preparing the tissue for more precise histological analysis while also reducing operative time and complexity.

Methods: When dissected, each level is excised between lymph nodes groups and put into a separate pot of formalin taking care to avoid rupture of any obvious pathological nodes.

The acute effects of alcohol on auditory thresholds.

Background: There is very little knowledge about alcohol-induced hearing loss. Alcohol consumption and tolerance to loud noise is a well observed phenomenon as seen in the Western world where parties get noisier by the hour as the evening matures. This leads to increase in the referrals to the "hearing aid clinic" and the diagnosis of "cocktail party deafness" which may not necessarily be only due to presbyacusis or noise-induced hearing loss.

The role of surgical audit in improving patient management; nasal haemorrhage: an audit study.

Background: Nasal bleeding remains one of the most common Head & Neck Surgical (Ear Nose and Throat [ENT]/Oral & Maxillofacial Surgery [OMFS]) emergencies resulting in hospital admission. In the majority of cases, no other intervention is required other than nasal packing, and it was felt many cases could ideally be managed at home, without further medical interference. A limited but national telephone survey of accident and emergency departments revealed that early discharge practice was identified in some rural areas and urban departments (where adverse socio-demographic factors resulted in poor patient compliance to admission or follow up), with little adverse patient sequelae.