Evidence-Based Pain Management: Building on the Foundations of Cochrane Systematic Reviews.

We discuss the history and current status of evidence-based medicine for the prevention and treatment of acute and chronic pain as it has developed in the Cochrane Collaboration's Pain, Palliative and Supportive Care Review Group.To date, the Pain, Palliative and Supportive Care Review Group has published 277 reviews and a further 11 reviews of systematic reviews summarizing the evidence for interventions. The Cochrane Library has readily available high-quality summaries of evidence of pharmacological interventions especially for postsurgical pain but also for chronic musculoskeletal and neuropathic pain.

Later careers - regenerating the medical workforce.

We have a medical workforce crisis where we have insufficient trainees, demonstrated by rota gaps, and in turn nearly half of advertised consultant physician posts cannot be appointed to. Most physicians retire around age 62, and already 5% of the total consultant workforce is those who have retired and returned. If those reaching retirement age chose not to retire but continue working less than full time this would, at least in part, benefit the workforce and utilise valuable skills and experience to the benefit of the individual, the wider medical community and therefore our patients.

Criticise care standards - but not nursing standards.

As a hospital consultant for 19 years, I am in an ideal position to observe the 'decline in nursing standards' referred to by the media. The nurses I work with are just as dedicated and caring as the nurses of 19 years ago. The difference is the work they are asked to do.

Surgery insight: Oncoplastic breast-conserving reconstruction--indications, benefits, choices and outcomes.

Until recently, the surgical management of breast cancer has centered around two main options--either tumor resection by carrying out breast-conserving surgery or mastectomy with or without reconstruction. Lately, techniques that combine the skills of resection with those of reconstruction in one procedure are leading to the emergence of a third approach--oncoplastic breast-conserving reconstruction. This approach involves reconstruction of resection defects either by volume replacement or by volume displacement.

A prospective audit of external cephalic version at term: are ultrasound parameters predictive of outcome?

This prospective study was designed to audit our provision of external cephalic version (ECV) but also to assess the relative importance of various ultrasound markers as indicators of a successful outcome. Data were collected between November 1998 and November 1999. There were 102 breech presentations at term and 47 women had an external cephalic version.