Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand.

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.

Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ.

Prevalence of methicillin-resistant Staphylococcus aureus colonization among older residents of care homes in the United Kingdom.

Objective: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among older residents of care homes in Leeds, United Kingdom, and to identify resident and care home risk factors for carriage.

Design: We conducted a cross-sectional prevalence survey of 715 residents from 39 care homes. All participants were tested for nasal colonization with S.

Improving referral information in community mental health.

This article explains how a questionnaire to improve the quality of information about clients referred to a community mental health team was devised. The questionnaire was drawn up with the help of the local advocacy service and service-user representatives, and led to improved information that enabled us to improve our service to clients.

Unusual consequences of heroin overdose: rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia.

A 29-yr-old man, known to be a heroin addict, was found at home totally unrousable, bent on his hips in the lotus position. On admission, he required frequent ventricular defibrillation, external pacing and infusion of calcium. A diagnosis of rhabdomyolysis caused by heroin and cocaine overdose was made.

The effects of dothiepin on subjects with rheumatoid arthritis and depression.

Background: The relative importance of direct analgesic and antidepressant effects of antidepressant drugs in rheumatoid arthritis (RA) is not clear.

Method: Forty-eight female out-patients with RA, with depression and/or anxiety, were entered into a double-blind, placebo-controlled study of dothiepin in doses up to 150 mg daily to assess the effects on mood [Hospital Anxiety and Depression (HAD) scale and Hamilton Rating Scale (HRS) for Depression], pain [visual analogue scale (VAS)] and disability [Health Assessment Questionnaire (HAQ)].

Results: Repeated measures multivariate analysis of variance revealed that treatment had a significant effect on pain (F(d.

Use of methadone in the morphine-tolerant burned paediatric patient.

We describe the successful use of methadone in the restoration of sedation and provision of analgesia in two morphine-tolerant, paediatric patients who had suffered significant thermal injuries and were undergoing mechanical ventilation. Both patients had exhibited escalating requirements for sedative drugs while undergoing ventilation yet remained inadequately sedated. The introduction of i.

The aetiology of bleeding peptic ulcer--as observed in a district general hospital.

A review was made of the hospital case notes of 124 patients admitted with symptoms of upper gastrointestinal haemorrhage due to bleeding peptic ulcer over a five-year period. A high proportion of the patients were found to be elderly and female, as observed by Walt et al 1986. This finding was more pronounced if the source of the bleed was a gastric ulcer.

Recurrent inguinal hernia: a personal study.

A personal series of 287 recurrent inguinal hernias repaired by a single consultant surgeon is presented. Four techniques of repair were employed in the series: Bassini operation; a posterior 'lace repair'; complete closure of the canal after division of the spermatic cord and local repair of isolated defects. The overall recurrence rate, 27 failures in 287 operations (9 per cent) is disappointing.