INTRODUCTION New-onset arrhythmias are a common problem in cardiothoracic surgery. They are also common following major non-cardiac surgery. This review examines the available literature to establish the incidence and significance of new-onset arrhythmias following major non-cardiothoracic surgery.MATERIALS AND METHODS A literature search was performed using the Medline and Pubmed databases using the terms 'postoperative arrhythmia', 'peri-operative arrhythmia', 'atrial fibrillation/flutter', 'supraventricular arrhythmia/tachycardia', 'cardiac complications' and 'non-cardiothoracic surgery'. Articles were cross-referenced for additional relevant publications and reviewed for data regarding new-onset arrhythmias following major non-cardiothoracic surgery.RESULTS There was considerable heterogeneity in the literature regarding cardiac monitoring, types of arrhythmias considered and potential associations investigated, thus hindering interpretation. The available data suggest that new-onset arrhythmias affect about 7% of patients following major non-cardiothoracic surgery. These arrhythmias are often associated with other underlying complications.
This is a rare but important diagnosis however we recommend that in patients with atypical histories, it should be included in the differential diagnosis.
POSSUM, V-POSSUM and P-POSSUM may not be robust tools for comparing mortality between populations undergoing elective and emergency open AAA repair as once thought. The development and successful validation of Cambridge POSSUM provides a unified model to describe both elective and emergency AAAs together and should be validated in other geographical settings.
Ann R Coll Surg Engl 2011; 93: 13-16 13 'Bare below elbows' is a phrase with which the majority of UK healthcare workers have become familiar in the last few years. In September 2007, Alan Johnson, Minister of Health, announced that all clinical hospital staff should be 'bare below elbows' (BBE) in order to improve hand and wrist hygiene and thereby reduce the spread of hospital-acquired infections (HAIs). A Department of Health (DH) paper was produced, 1 entitled Uniforms and Workwear, to explain the policy further.Whilst there is good evidence that handwashing is vitally important in preventing the spread of HAIs, there is no evidence that being BBE has any effect on handwashing efficiency. The literature cited in the DH paper merely discusses attitudes of patients towards various clothing policies, and also the outcome of various laundry methods. It also comments on standards of dress expected of doctors by patients, in light of their professional positions. A subsequent publication suggests that patients have a preference for doctors to wear more traditional, professional clothing. 2The object of this study was to establish whether doctors who are BBE carry significantly fewer bacteria than those who are not and, second, to establish whether handwashing is more effective in reducing bacterial colonisation in those doctors who are BBE. Subjects and MethodsSixty-six doctors volunteered to take part in the study during a normal working day: they were given no advance warning and the study was conducted throughout the working day from 9.00 am to 5.00 pm. Thirty-eight doctors were BBE and 28 were not bare (NB). A questionnaire was completed for each participant detailing grade, specialty, recent clinical activity, dominant hand, presence of rings and wrist watches in addition to their BBE/NB status. There is a paucity of evidence to support this policy. One may hypothesise that absence of clothing around wrists facilitates more effective handwashing: this study aims to establish whether dress code affects bacterial colonisation before and after handwashing. SUBJECTS AND METHODS Sixty-six clinical staff volunteered to take part in the study, noting whether they were bare below the elbows (BBE) or not bare (NB). Using a standardised technique, imprints of left and right fingers, palms, wrists and forearms were taken onto mini agar plates. Imprints were repeated after handwashing. After incubation, colonies per plate were counted, and subcultures taken. RESULTS Thirty-eight staff were BBE and 28 were not. A total of 1112 plates were cultured. Before handwashing there was no significant difference in number of colonies between BBE and NB groups (Mann-Whitney, P < 0.05). Handwashing reduced the colony count, with greatest effect on fingers, palms and dominant wrists (t-test, P < 0.05). Comparing the two groups again after handwashing revealed no significant difference (Mann-Whitney, P < 0.05). Subcultures revealed predominantly skin flora. CONCLUSIONS There was a large variation in number of colonies cultured. Handwas...
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