Surgery RSS feed: Current Issue. Surgery is an authoritative, comprehensive collection of educational reviews that present the current knowledge and practice of surgery Surgery also indicates recent advances that improve the understanding of disease and the safe and effective treatment of patients It comprises concise and systematically updated contributions that are produced over a three-year cycle. Surgery is an excellent didactic tool to help consultant surgeons train their junior staff to become safe and competent surgeons. http://www.surgeryjournal.co.uk/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Surgery0263-9319305May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.surgeryjournal.co.uk/article/PIIS0263931912000701/abstract?rss=yesContents10.1016/S0263-9319(12)00070-1Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XOFCOFChttp://www.surgeryjournal.co.uk/article/PIIS0263931912000725/abstract?rss=yesEditorial Board10.1016/S0263-9319(12)00072-5Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-Xiihttp://www.surgeryjournal.co.uk/article/PIIS0263931912000361/abstract?rss=yesAbstract: Proteins serve a wide variety of functions. They are made by the sequential incorporation of amino acids in an order that is determined by genes and which in turn determine the final structure and thus the function of the protein. Proteins are constantly being synthesized and broken down at rates which exceed the amount of protein consumed in the diet and the equivalent amount of nitrogen that is excreted as urea in the urine. Some amino acids can be synthesized in the body (non-essential amino acids) but others (essential amino acids) must be supplied from dietary proteins in amounts that match the amounts that are oxidized. Hence the criterion of adequacy of a diet with respect to protein is its ability to maintain nitrogen balance in an adult and its ability to support normal growth in a child. During some critical illnesses there appears to be a constraint on the rate at which some non-essential amino acids can be synthesized, so that clinical benefits have been seen from supplementing the diet with these ‘conditionally-essential’ amino acids. Moreover, following surgery or during severe illness there is an increase in amino acid oxidation that can lead to muscle wasting. It is important to minimize the loss of lean tissue, but it may not be possible to prevent it completely by dietary means.Basic metabolism: proteinPeter W. Emery10.1016/j.mpsur.2012.02.008Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XBasic science209213http://www.surgeryjournal.co.uk/article/PIIS026393191200035X/abstract?rss=yesAbstract: The location and size of the intensive care unit (ICU) should be carefully planned to take into account the types of patients currently needing the unit and which services are planned for the future. The Health Building Note (HBN) 57 gives precise detail of the building requirements for a new adult critical care facility. This has been recently amended to account for the NHS commitment to patient privacy and dignity. Comprehensive Critical Care. A Review of Adult Critical Care Services, published in 2000, gives direction and advice on issues around organization and staffing. Though not produced as a national service framework, it makes key recommendations about the need for a ‘critical care delivery group’, intensive care trained medical staff, level of patient dependency, audit collection and many other aspects of the ICU. It also gives a timeframe for introducing these measures.Levels of medical staffing and patterns of work are discussed. For many ICUs a closed system with a ‘week-on’ consultant pattern produces good results even if medical staff are working with a special interest in intensive care rather than being specifically intensive care trained.Design, organization and staffing of the intensive care unitSean Bennett10.1016/j.mpsur.2012.02.007Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XCritical illness and intensive care I214218http://www.surgeryjournal.co.uk/article/PIIS0263931912000324/abstract?rss=yesAbstract: More than 10,000 intensive care patients are transferred each year in the UK, of whom the vast majority are accompanied by staff from the referring hospital. The high frequency of transfer of critically ill patients is primarily due to the escalating complexity of healthcare, the concentration of skills into specialized regional centres, and the relative lack of availability of intensive care unit (ICU) beds. The care practised during the constraints of patient transfer (whether within or between hospitals) should attempt to mirror the detailed attention provided in the hospital ICU, and it is the responsibility of the transport team to ensure the efficacy of the process and safety of the patient. This is achieved through careful preparation and planning and preparation starts with adequate and appropriate training of transfer personnel as well as selection of equipment which is fit for purpose. Success is based on anticipation and prevention of potential complications and hazards to the patient and transfer team. This article gives an overview of the hazards, organization, and planning of patient transfers, and highlights the importance of interdisciplinary teamwork, good communications, and appropriate decision-making. It also discusses special situations encountered in the transfer or retrieval of patients with complex needs, such as those requiring intra-aortic balloon counterpulsation or extracorporeal membrane oxygenation.Transporting the adult critically ill patientTerry Martin10.1016/j.mpsur.2012.02.004Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XCritical illness and intensive care I219224http://www.surgeryjournal.co.uk/article/PIIS0263931912000348/abstract?rss=yesAbstract: This article explores the provision and organisation of critical care services in the UK and examines the issues surrounding admission to, discharge from and the withholding of critical care.Critical care expansion in the UK in recent years has centred on the provision of increased numbers of beds and the development of outreach services. Despite the expansion in critical care there is difficulty in matching supply and demand for beds. There remains controversy regarding the effectiveness of outreach in improving outcomes for patients referred to critical care. The discharge of patients from critical care has also come under scrutiny since mortality rates are higher for patients discharged out-of-hours. Patients' needs following critical care are carefully planned with the base medical teams because readmission to critical care is associated with increased mortality.Scoring systems are used in critical care to compare outcomes between critical care units and to facilitate research but cannot predict outcome for individual patients.The decision that patients will not benefit from critical care admission can be one of the most difficult. Many patients who would not have been considered for organ support previously are now admitted to critical care with pre-determined limits of treatment. Involvement of the base team is integral to making decisions for these patients.Criteria for intensive care unit admission and severity of illnessMiriam Baruch, Ben Messer10.1016/j.mpsur.2012.02.006Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XCritical illness and intensive care I225231http://www.surgeryjournal.co.uk/article/PIIS0263931912000312/abstract?rss=yesAbstract: In this article we aim to describe some of the key principles of this relatively new speciality. Intensive care medicine has become an essential and integral part of hospital medicine which uses a system-based approach to the care of a patient, underpinned by detailed understanding of physiology and pharmacology. Modern critical care embraces multi disciplinary team work in all aspects of patient care from admission through to discharge (including end-of-life care and organ donation).Care of the critically ill patientKwabena Mensah, Stanislaw Jankowski10.1016/j.mpsur.2012.02.003Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XCritical illness and intensive care I232237http://www.surgeryjournal.co.uk/article/PIIS0263931912000300/abstract?rss=yesAbstract: There has been documented evidence of tracheostomies for over two millennia with the majority being descriptions of relieving acute upper airway obstructions in an emergency situation. The refinement of anaesthetic and surgical techniques resulted in an increase of the frequency and success of the procedure and the latter half of the 20th century saw tracheostomies being used increasingly as an adjunct to long-term respiratory support, not only in patients who had lost their upper airway but also in patients who had limited bulbar function and reduced ability to clear secretions via coughing and expectorating. Further technical developments have resulted in the adoption of the percutaneous dilatational tracheostomy (PDT) as the predominant technique with it being put to frequent use to facilitate ventilatory weaning in intensive care. In the UK approximately 16% of adult intensive care patients undergo PDT and if care of these patients is to be maintained at a high level clinicians must have a working knowledge of upper airway anatomy, indications for the procedure, complications and the ongoing care and management of such patients.Indications for and management of tracheostomiesJoseph F. Cosgrove, Sean Carrie10.1016/j.mpsur.2012.02.002Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XCritical illness and intensive care I238243http://www.surgeryjournal.co.uk/article/PIIS0263931912000336/abstract?rss=yesAbstract: Critical care outcomes are becoming increasingly important in the modern NHS and frequently intensive care unit (ICU) performance is judged in this manner. However the eventual outcome of any individual patient or patient group is dependent upon a complex process that precedes the end-point. This article reviews the aspects of ICU structure, process and outcome that can be used as quality indicators or to measure performance.Outcome from intensive care and measuring performanceRob Whittle, Jonathan Shelton10.1016/j.mpsur.2012.02.005Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XCritical illness and intensive care I244248http://www.surgeryjournal.co.uk/article/PIIS0263931912000294/abstract?rss=yesAbstract: A significant number of patients develop a critical illness requiring organ support each year. The vast majority of patients will survive to hospital discharge. However, these patients may take many months and even years to recover their pre-morbid level of function. Even at 12 months quality of life is significantly poorer than that of the general population, and many patients will not have returned to work. Patients may acquire a wide range of physical and psychological complaints related to their critical care stay, which may benefit from specialist referral. These problems however are often overlooked. Outcomes may potentially be improved by the implementation of an early individualized multidisciplinary rehabilitation programme. Assessment and rehabilitation as indicated should begin whilst the patient is still in critical care and continue on the wards, and following hospital discharge into the community. Specialized critical care follow-up clinics may have a role in detecting and managing specific post-critical care morbidity.Long-term consequences of critical illnessKaye L. Cantlay10.1016/j.mpsur.2012.02.001Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XCritical illness and intensive care I249253http://www.surgeryjournal.co.uk/article/PIIS0263931912000683/abstract?rss=yesFor questions 1–4, select the statements which are true and which are false. The correct answers are given below. When considering the criteria for intensive care unit admission and severity of illnessTest yourself: MCQ and extended matchingMichael G. Wyatt10.1016/j.mpsur.2012.03.002Surgery 30, 5 (2012)2012-05-01Surgery2012-05-01305S0263-9319(12)X0005-XTest yourself254255